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  • Delfini Same Page Online Resources
    what we ve been professing patients and healthcare professionals should be on the same evidence based page Direct Link http besthealth bmj com x index html Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Cochrane Informed Health Online A group called Informed Health Online based in Melbourne Australia provides evidence based information for patients clinicians and others It is a non profit foundation found at http www informedhealthonline org This is a nice website for consumers because it summarizes systematic reviews from Cochrane abstracts of Cochrane Reviews are available without charge The nice thing about this site is that you can get to the abstracts of Cochrane Reviews and the consumer summaries from one website and it is free Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Consumer Reports Best Buy Drugs The mission of the Consumer Reports Best Buy Drugs project is to provide consumers and their doctors with information to help guide prescription drug choices based on effectiveness a drug s track record safety and price This appears to be a good source of information since it is based on the work of the Oregon Health Science University Evidence based Practice Center which uses a rigorous approach to evaluating science http www bestbuydrugs org Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Delfini Rx Messaging Scripts Delfini Messaging Scripts See Samples for evidence based messages for patients on specific clinical topics Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message DIPEx Illness information for patients including patients talking about their experiences with illness can be found at this site Many of the modules are produced by professionals involved with the Cochrane Collaboration The site provides patients with information by condition but also through interviews with patients that you can hear directly online It also provides information about other resources available to patients http www healthtalkonline org Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Medline Plus for Patients MEDLINEplus Medline Plus provides extensive authoritative information from National Library of Medicine the National Institutes of Health and other trusted sources on over 650 diseases and conditions Included are a medical encyclopedia and a medical dictionary extensive information on prescription and nonprescription drugs health information from the media and links to thousands of clinical trials There is no advertising on the site nor does MEDLINEplus endorse any company or product Although the site uses criteria it should be noted that there

    Original URL path: http://www.delfini.org/page_SamePage_OnlineResources.htm (2016-02-01)
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  • Delfini-KPHI:VTE QI Project and Clinical Guideline
    of anticoagulant prophylaxis What is the evidence regarding bleeding from thromboembolism prophylaxis with the various appropriate agents What We Learned and Recommend To Others The risk of VTE in total hip replacement THR and total knee replacement TKR surgery without VTE prophylaxis is frighteningly high with reported figures from 41 to 85 The level of evidence LOE is fair for reduction of overall DVT rates with mechanical compression devices used in conjunction with recommended pharmacological agents LOE is inconclusive for reduction of symptomatic DVT proximal DVT and PE rates Current national guidelines are conflicting and include evidence with significant threats to validity With mechanical compression and pharmacological prophylaxis some studies report incidence rates of 10 to 15 Based on our evidence review and evidence synthesis the KPHI VTE Prevention Guideline Team recommends that Mechanical compression devices be used in conjunction with recommended pharmacological agents enoxaparin warfarin fondaparinux or aspirin Both compression devices and recommended pharmacological agents be continued at least through discharge to achieve the lowest possible DVT rates in THR and TKR surgery Until further evidence is available decisions regarding the extension of VTE prophylaxis beyond hospitalization be individualized following risk assessment Aspirin alone not be used as VTE prophylaxis in THR and TKR surgery because there is fair evidence that aspirin alone is not effective in preventing VTE and in one study the DVT rate was 47 Details regarding specific mechanical devices drugs bleeding risks the quality of the evidence dosing etc are available immediately below Read the interview with medical leader Karen Ching MD about how to make such evidence based quality improvement projects successful Project Outline Phase I Identify Team Leaders from Medical Education and the EBM Working Group solicited interest among clinical staff With Delfini s guidance a multidisciplinary team was formed including orthopedic surgeons a vascular surgeon hospitalists pharmacy nursing and an EBM working group leader Phase II Select Project Delfini provided advice and training in successful project selection Total knee and total hip replacement surgery was identified as a topical focus area The team agreed upon development and implementation of a clinical practice guideline as their EBM clinical improvement project Phase III Develop Project Outline Existing guidelines were reviewed for applicability validity appropriateness and currency A focus statement was created Focus statement 7 25 08 A standardized evidence based DVT prophylaxis protocol for the known high risk total knee and hip replacement population Key issues Focus on prophylaxis for joint replacement surgery Bleeding risk from pharmacologic prophylaxis Duration of therapy for anticoagulant prophylaxis When to start Role of preoperative prophylaxis Key Questions Clinical Questions Addressed in this QI Project 1 What is the evidence that thromboembolism or DVT prophylaxis with various agents reduces mortality and clinically significant morbidity in hip and knee replacement surgery 2 What is the evidence regarding timing of anticoagulant prophylaxis for appropriate agents when used for prevention of thromboembolism in hip and knee replacement surgery What is the evidence regarding starting anticoagulant prophylaxis What is the evidence regarding duration

    Original URL path: http://www.delfini.org/Showcase_Project_VTE.htm (2016-02-01)
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  • Irritable Bowel Syndrome (IBS) Clinical Practice Guideline
    inclusion criteria include Women under the age of 55 years Currently suffering with IBS C or Chronic Idiopathic Constipation No satisfactory response to other available treatments and or patients who had satisfactory improvement of their symptoms with prior Tegaserod treatment Key exclusion criteria include History or current diagnosis of cardiovascular ischemic disease Symptoms suggestive of cardiovascular ischemic disease Presence of any cardiovascular risk factors according to NIH guidelines Uncompensated depression or anxiety or suicidal ideation or behavior To become part of this program patients should contact their physicians to inquire about the protocol and evaluate if they meet the criteria At the origination of this guideline in 2003 Delfini had found there was sufficient evidence of benefit in favor of tegaserod as compared to placebo When tegaserod was removed from the market all information about tegaserod was removed from this site At this time this information is still removed from this site until such time as the evidence is re reviewed INTRODUCTION TO THE IBS GUIDELINE RESOURCE KIT About the Kit This kit contains information about the best available evidence at the date of this guideline on IBS diagnosis and treatment to assist you and your patients in making testing and care management decisions Tools and tips are also included Our Approach See the Guideline Documentation in Guideline Resource Information for details Our approach emphasizes evidence and patient centered care We used an explicit evidence based methodology based on the principles and systematic methods for guideline development first conceptualized by David Eddy MD PhD and operationalized by Michael Stuart MD during his career at Group Health Cooperative a consumer owned health care system in Washington State renown for its quality care This work was sponsored and funded by Novartis Our approach to this work was to apply the same high and identical standards we apply to all our work and was modeled on prior work done without industry support Who We Are Delfini Group LLC is devoted to assisting others learn how to apply evidence and value based medicine principles in an easy to understand way through training consultations resources and tools Detailed information about us is available at www delfini org where you can also access the guideline Guideline Resource Kit Contents NOTE 01 2012 Update Not incorporated only available as separate document see Downloads Guideline Resource Info Explicit Evidence Based Clinical Practice Guideline Resource Information March 2003 Guideline materials designed primarily for primary care physicians and other clinicians who diagnose and manage IBS in adult patients and for professionals who plan and implement clinical quality improvement projects These materials may be useful as is or may be helpful as seeds for creating information and decision aids that meet local needs Webpage Guideline Resource Info Algorithm Download PDF For Patients Clinicians Information Decision Aid for Adult Patients and Clinicians March 2003 Decision support including information and resources on IBS treatment options drug risks and benefits and general information about evidence based medicine Webpage Info for Patients Clinicians Download PDF

    Original URL path: http://www.delfini.org/page_ibs.htm (2016-02-01)
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  • Delfini Same Page: General
    details Read our Health Care Information Source Cautions at Notices DelfiniGram GET ON OUR UPDATE LIST Contents What matters to patients Here s what we think Delfini Approach to Patient Decision making Recommended Reading Physician Patient Communications Decision making Conveying Risk Adherence What matters to Patients Here s what we think click here Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Delfini Approach to Patient Decision making Studies show that physicians tend to describe decisions to patients but tend to exclude describing benefits harms risks costs uncertainties and alternatives Patient centered care is about choice Physicians need to be prepared to discuss all these areas with patients Studies also show that patients have individual preferences for decision styles depending upon their unique circumstances These styles are autonomous physician directed and shared Autonomous decision making is performed solely by the patient Physician directed means the physician chooses Shared decision making is jointly performed by physicians and patients Patient centered care involves the patient in deciding which decision style to use based on that patient s own needs values and preferences Physicians may wish to favor a more prescriptive style where the evidence is strong Shared decision making is often most optimal where there are uncertainties and or equally reasonable alternatives Patient choice is at the heart of patient centered care Patient Decision making Model How you communicate the differences in treatment choices in patients hugely matters Studies show an acceptance rate of 88 to 31 Click here to learn more about estimates of effect Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Recommended Reading Physician Patient Communications Decision making Conveying Risk Adherence Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Physician Patient Communications see also Delfini Patient Encounter Map for Information Engagement Beck RS Daughtridge R Sloane PD Physician Patient Communication in the Primary Care Office A Systematic Review JABFP 2002 15 25 38 The Journal of the American Board of Family Practice PMID 11841136 Abstract Delfini commentary here Hall JA Roter DL Katz NR Meta analysis of correlates of provider behavior in medical encounters Medical Care 1988 26 657 675 PMID 3292851 Abstract Stewart MA Effective Physician Patient Communication and Health Outcomes A Review CMAJ 1995 152 1423 1433 PMID 7728691 Abstract Delfini commentary here Click here to share this page If you are at an entry URL title copy URL then click share button to paste into body text of your message Decision making Epstein RM Alper BS Quill TE Communicating evidence for participatory decision making JAMA 2004 May 19 291 19 2359 66 Review PMID 15150208 Abstract Say R Thomson R The importance of patient preferences in treatment

    Original URL path: http://www.delfini.org/page_SamePage_General.htm (2016-02-01)
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  • Delfini Program Self-Funded Health Plan: Sample
    Use of our website implies agreement to our Notices Citations for references available upon request Home What s New Blog Seminars Services Delfini Group Publishing Resources Sample Projects Notices About Us Our Work Testimonials Other Site Search Contact Info Updates Quick Navigator to Selected Resources Tools Educational Library The Healthcare Information Problem Tutorials DelfiniClick commentaries On the Same Page patient decision support Evidence Messaging Scripts Delfini Publications Medical Leader Interviews Glossary Recommended Reading Recommended Web Links Delfini Critical Appraisal Flier Get DelfiniGram Updates SAMPLE AGENDA Self funded Health Plan Program The Quality and Cost Problem in Health Care Improving Quality through Evidence based Medicine Stories Medical Literature Evaluation Training Critical Appraisal Training Sampler More on Critical Appraisal Case Studies Primer on Quality Improvement Phases Steps Evaluating Quality in Health Care Organizations Health Care Quality System Assessment Tool Selecting Good Projects Message From Self funded Health Plan Program Administrator Conference Recommendation About a year ago I attended a seminar presented by Delfini Group This seminar changed the way I think about managing my company s self funded health care plan for our 2700 employees I was so profoundly moved by what I was taught that I wanted to learn more and to encourage others from my company and among my peers to join me in this discovery process I m excited that the opportunity has now come Delfini Group will present a special one day seminar especially for managers of self funded health plans I m grateful that this seminar is being hosted by the Omni Medical Group at no charge to attendees as an educational outreach to business leaders across the state This seminar promises to help us Gain insights into ways to simultaneously reduce costs and improve patient care quality Learn how best to evaluate health care quality it s not done the way you might think Hear success stories of health care improvements driven by purchasers If your company is like mine health care cost is one of senior management s fastest growing concerns In 1980 health care comprised 8 8 of the U S gross domestic product GDP In 2000 it was up to 13 this year it will likely climb to nearly 16 2 trillion and it s expected to reach 20 of the GDP by 2015 Businesses must find a long term solution to runaway health care costs and I believe a significant part of the answer lies in ensuring our participants receive the most effective care medicine supported by the science of the best evidence Evidence based medicine EBM has become a buzzword in today s health marketplace but it is estimated that fewer than one out of four doctors actually practice medicine using the best available evidence If we wish to change our cycle of spiraling cost and diminishing health then we must understand and purchase care from medical providers who truly practice EBM As purchasers our power is in our purse And I d like to have as many as possible in

    Original URL path: http://www.delfini.org/Showcase_Program_Self-FundedHealthPlans.htm (2016-02-01)
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  • Delfini-BCIdaho: Spine Care
    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 Read Our Blog Menu Use of our website implies agreement to our Notices Citations for references available upon request Home What s New Blog Seminars Services Delfini Group Publishing Resources Sample Projects Notices About Us Our Work Testimonials Other Site Search Contact Info Updates Quick Navigator to Selected Resources Tools Educational Library The Healthcare Information Problem Tutorials DelfiniClick commentaries On the Same Page patient

    Original URL path: http://www.delfini.org/Showcase_Project_SpineCare.htm (2016-02-01)
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  • Evidence Based Health Care: Delfini References
    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 Renal Nutritionist Clinical Guideline Project Team Member Carrie Mukaida MS RD CSR Renal Nutritionist KP Nephrology Division This letter is to endorse the Educational Session Proposal Evaluating the Medical Literature for Validity and Usefulness by Michael Stuart MD and Sheri Ann Strite Delfini Group I have had the privilege and honor to be part of a group of physicians and pharmacists who are developing practice guidelines for the management of chronic kidney disease CKD KP Hawaii is committed to promoting and implementing evidence based medical EBM practice and integrating this into our electronic medical records system Our organization s leadership arranged to have the Delfini Group serve as consultants to this team based on their prior collaborative work and Delfini s successful track records Although we have been working with Mike and Sheri only since April our CKD group has been extremely impressed by their knowledge organization and planful guidance As a team they are very skillful at facilitating teleconferences with focused discussions and action planning On July 13 2005 Mike and Sheri came to Honolulu to conduct a full day training in critical appraisal of the medical literature foundation skills for any EBM practice They have developed a wealth of tools including checklists process flow models reading and writing tips and evidence grading tools to help even a novice reviewer feel that he can unlock the mysteries of medical mumbo jumbo to read between the lines and separate the wheat from the chaff And there is a lot of chaff out there with about 10 000 articles being published in the medical literature weekly Mike and Sheri are gifted facilitators and passionate educators I have rarely encountered workshop presenters who are so well prepared and well versed in their subject matter Both are engaging up beat and empowering in their presentations They are extremely generous with their knowledge and expertise explore their website delfini org to examine some of their tools checklists etc Registered Dietitians in general unfortunately have not been well educated in critical appraisal skills to evaluate medical literature Although we are making excellent progress in developing practice guidelines too many of us rely blindly on others to review the literature and accept published data at face value In fact one of my young dietitian acquaintances recently commented to me that she was developing evidence based practice guidelines When I asked her about her methodology she replied that she was citing whatever was published to support her recommendations She admitted that she thought that that was what EBM meant to cite published data whether or not it was critically reviewed Many professionals physicians included assume that an article that makes it through the gauntlet of an editorial review board has met high standards of research Mike and Sheri have also developed a package of teachable skills for conducting meetings teleconferences and minute taking These skills include how to develop agendas and templates for minutes keep discussions focused build consensus and achieve clarity among participants In fact they were recently invited to do such a training for a large organization Their client list and endorsements are impressive Again reference their website Sincerely yours Carrie Mukaida MS RD CSR Renal Nutritionist KP Nephrology Division Insurer Utilization Management Leader N ame Company Name confidential Medical Director Utilization Management Insurance Company I have known Michael Stuart and Sheri Strite for many years in their capacity at Delfini When I first met them I was a primary care physician and I have continued to attend their sessions since moving Mike and Sheri demonstrate an excellent work ethic and are incredibly hard working In the time I have known them they continue to refine and customize the content and training experience they deliver to fully suit the needs of whomever they are training They truly put their heart and soul into their work and are very committed to the training of the EBM evidence based medicine paradigm which is so lacking in America today Although the concept is gaining some traction it still seems pitifully lacking where the rubber meets the road viz when the physician is doing his her medical decision making with the patient in their office All you have to do is read through the Delfini bios to realize what incredible experience Mike and Sheri have They are highly effective trainers not just in enabling people to do the work but also in boosting their motivation confidence and inspiration Many of the doctors who were fundamentally EBM ignorant prior to a session with Michael and Sheri come away from that experience applying EBM principles in their daily practice and sharing what they have learned with their fellow practitioners I am simply unaware of any other group person or persons who are offering the full range of services and expertise that Delfini can offer particularly in such an effective simplified and practical way For all these reasons I have been looking for ways to incorporate their services into my company and have continued to work with Sheri and Mike to come up with innovative ways to bring this message further down the line to inform patients and business group leaders to help impact the EBM equation As you can see I am very excited as to what Delfini has to offer I fully believe these two have the potential to have a significant impact on the way we practice medicine today Not because they are the only ones who are working to promote EBM but because they are two of the very few voices in America who can present EBM in such

    Original URL path: http://www.delfini.org/delfiniReferenceLetters.htm (2016-02-01)
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  • Evidence Based Health Care: Delfini Testimonials
    optimally invaluable After one month for a Pharmacy Therapeutics Committee consultation for one of our clients The evaluation results look very good Proof of impact people are already starting to use the tools and material in real life 1 Parkview Hospital and Parkview North have already changed the way addition to formulary requests are presented at their local PNT The docs like the organized approach 2 The three Community Hospitals approved the System PNT at their quarterly joint med staff officers meeting last week We take the matter before Parkview Hospital next week but don t think there will be any problems there Well done Yes you can use this You earned it Six months later It has been six months since the Delfini Group customized an evidence based training program to help us change our processes for drug reviews We have already experienced real success which we expect to be sustainable and which will improve the care we provide to our patients and our ability to use our resources optimally The concepts and skills learned in the training along with the tools and process steps were invaluable to us and have helped us transform our system Highly recommended One and a half years later Reference Provided by W David Holloway MD Sr VP Chief Quality Officer Parkview Health Parkview Health has seven hospitals five boards four medical staffs and all of the inherent complexities of such a structure Two years ago we consolidated our various hospital pharmacy operations into one system support function One goal was to decrease variation within medication class in other words standardize the formulary across hospitals and medical staffs An important milestone was creation of a System Pharmacy and Therapeutics Committee with physicians from the four staffs That said we took this opportunity to structure the new committee s decision making around evidence and not just physician preference and advocacy as had been the approach at the local P T s Mike and Sheri led a group of physicians nurse pharmacists and administrators through a one day EBM course tailored specifically to a system level pharmacy and the types of decisions we might encounter By the end of the day we had 1 created the structure and function of the new committee 2 general agreement of how we would use EBM in decision making and 3 a good understanding of the resources functions needed from pharmacy to support the new committee In addition we introduced this core group of clinical leaders to the concepts and methods of EBM This deep awareness has helped many times in other areas such as better clinical pathway development This EBM training was a big ah ha needed toward critical mass The System P T is running well Formulary variation is decreasing New products must be accompanied by proper critical appraisal The committee can still decide to look beyond the evidence we haven t banished politics from the planet yet But we are definitely making better decisions and we see fewer physicians willing to approach without good RCTs Also our flagship hospital about 550 beds decommissioned their separate P T committee choosing to cast its fate with the System group This is a nice endorsement by the tertiary center And EBM products Mike I want to thank you for the outstanding evidence review and synthesis Delfini did for our medical group on ACE inhibitors and angiotensin II receptor blockers ARBs in heart failure When I presented the synthesis to our cardiologists they enthusiastically complimented Delfini They uniformly felt the synthesis was extremely thorough well organized and highly useful evidence based information Another example of Delfini s superb work I can t thank you enough for helping us navigate a challenging area Nicole O Kane PharmD InterHospital Physicians Association Portland OR instrumental role in the enhancement of our processes ideas to efficiently use available resources improved our efficiency I ve been attending seminars with the Delfini Group since 2001 They have played an instrumental role in the enhancement of our P T process Their programs mix together an enthusiasm for evidence based medicine with factual market driven ideas to efficiently utilize the available resources The Delfini programs motivated me to plan a health system retreat in 2002 The retreat was an opportunity for multiple P T committee members hospital primary care clinics health plan and supporting staff to explore the importance of evidence driven decisions in the P T process The program included Delfini presentations and working sections introducing tools to improve efficiency Of course the retreat was just a beginning a starting point to build upon And build we have Our P T presentation format and discussions have become more efficient and we have standardized decision algorithms that help during crossroad discussions for an individual therapy The evidence will never have all the answers But this process brings a framework of support that has improved efficiency and I believe a greater satisfaction for committee members with the difficult task of P T therapy evaluations and literature review Maribeth M Bettarelli PharmD Clinical Associate Clinical Drug Information Resources Caremark Inc Northbrook IL invaluable guidelines and tools used almost daily wonderful assets extremely useful Hi Mike and Sheri I hope you re both doing well If you don t remember me I last saw you at the Clinical Practice Guidelines Clinical Improvement Project Workshop in Fort Lauderdale in May Since then I left Walgreens Health Initiatives and started in the new Drug Information Team at Caremark I ve been here since mid August and have enjoyed it so far My current position entails the review of off label diagnoses for medications in our Prior Authorization program If you remember I had asked about the evaluation of off label diagnoses at the last workshop The guidelines and tools that you provided have been invaluable and are used on an almost daily basis as I review journal articles and consensus guidelines and write clinical consults These references along with those found on the web

    Original URL path: http://www.delfini.org/delfiniTestimonialsPharmacyTherapeutics.htm (2016-02-01)
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