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3	Outcomes of Needs Assessment Foundation of medical education Provide structure to information that health-care professionals need to assimilate to provide best care. Provide perspective and focus to program. Goal: Improve quality of health care provided to public
4	Developing Needs Assessments Identify educational needs of health-care professionals. Assess available information. Validate clinical relevance. Critically appraise information. Summarize.
5	Identify Educational Needs Sources Evaluations from past programs Suggestions from staff or faculty Educational planning committee ideas Recent clinical literature Request for proposal Disconnect between clinical observations and guidelines
6	Identify Educational Needs Define question Define target audience Define overall educational need
7	Assess Available Information Develop a search strategy. Define key words Consider clinical evidence from multiple sources. Systematic reviews (SR), meta-analyses Clinical trial data: randomized, cohort, or case studies Clinical practice guidelines Consensus statements, expert opinions Journal articles Textbooks
8	Assess Available Information Hierarchy of evidence Meta-analyses Randomized clinical trials (RCT) Cohort studies Case-control studies Expert opinions
9	Assess Available Information Consider epidemiologic evidence from multiple sources Patient advocacy groups National health-focused organizations American Heart Association, American Lung Association Government offices Centers for Disease Control National Institutes of Health National Cancer Institute State government health department
10	Assess Available Information How many people are affected annually? How many people are directly affected? How many people are indirectly affected? What is the risk to the patient? What is the risk to the health-care provider?
11	Assess Available Information Do various sources of information tell the same story? Does daily practice of medicine follow established guidelines? Do patient outcomes—locally or nationally—reflect what are expected based on guidelines or standards of care? Can patient outcomes be improved?
12	Assess Available Information ACCME Exemplary Compliance Needs-assessment data from multiple sources are consistently used to plan and evaluate activities.
13	Validate Clinical Relevance What is the impact of this issue on patient care, health, and well-being? Talk with faculty. What is the impact of this issue on outcomes relevant to patients? Morbidity Mortality Improvement of symptoms Reduction of costs
14	Validate Clinical Relevance What is the impact of this issue relative to the disease state? Talk with faculty Outcomes relevant to disease state Physiologic Intermediate Surrogate end points: May or may not reflect patient outcomes Blood pressure Blood chemistry Physiologic function Pathologic findings
15	Critically Appraise Information Are guidelines or standard of care published? Who is developing guidelines, standards of care, and recommendations? Have experts developed a consensus statement or recommendations? What are the prevailing and emerging concepts? Are materials available for target audience? Has the target audience changed behavior to incorporate guidelines, standards of care, or recommendations?
16	Critically Appraise Information What are the consequences of the health-care issue? What are the short-term consequences for the patient? For the health-care provider? What are the long-term consequences for the patient? For the health-care provider? What information do patients or their caregivers have? What information do patient advocacy groups make available?
17	Critically Appraise Information What information do other CME providers make available? What is the scope of their reach? Who are their target audiences?
18	Critically Appraise Information What is the burden of the health-care issue? To the patient? To the health-care provider? To the health-care system? To society?
19	Summarize Match type or source of information with target audience needs National incidence of health-care issue for national meeting Regional incidence of health-care issue for regional or local meeting Compare regional incidence with national incidence Identify information available to specific groups of health-care providers about which other providers need to be aware. Treatment suggestions presented at national meeting How can patient care be improved?
20	Summarize Identify improvements in diagnostic procedures. Identify alternate treatment options. Identify tools to improve patient compliance with treatment plans. Identify differences between published patient outcomes and local/regional patient outcomes. What needs to change to improve patient outcomes?
21	Summarize Develop statement of need from critical appraisal. Discuss ideas with faculty. Identify real needs of target audience. Develop learning objectives Talk with faculty. Identify educational topics from needs assessment.
22	Case Study How should childhood obesity be managed? Talk with faculty. Check information provided by American Academy of Pediatrics, The Endocrine Society, The American Association of Clinical Endocrinologists, American Academy of Family Physicians. Check epidemiologic information provided by NIH, CDC, state government health department.
23	Case Study Target audience: school nurses Do recommendations exist for nurses? Sources National Association of School Nurses (http://www.nasn.org/) The Society of Pediatric Nurses (http://omni.ac.uk/browse/mesh/D010371.html) American Pediatrics Association The Pediatric Endocrinology Nursing Society (PENS, http://www.pens.org/) National Association of Pediatric Nurse Practitioners (NAPNAP, http://www.napnap.org/index_home.cfm) Centers for Disease Control National Institutes of Health
24	Case Study Search terms Childhood obesity guidelines Childhood obesity nursing guidelines
25	Case Study: Search Results Current guidelines Evaluation and treatment of childhood obesity¹ University of Texas at Austin, School of Nursing, Family Nurse Practitioner Program. 2004 May. Prevention of pediatric overweight and obesity² American Academy of Pediatrics Committee on Nutrition.
26	Case Study: Search Results American Academy of Pediatrics Overweight and Obesity We Can! (Ways to enhance children's activity and nutrition) National Association of Pediatric Nurse Practitioners (NAPNAP) 26th Annual Conference. Keeping Children Healthy and Fit. Carolyn Montoya, MSN, CPNP
27	Case Study: Search Results Centers for Disease Control National Health and Nutrition Examination Survey (NHANES): Only survey collecting data from actual physical examinations on a cross-section of Americans. 1999–2002 NHANES data indicate that an estimated 16% of children and adolescents ages 6–19 years are overweight. Past 2 decades: Number of overweight children and adolescents has doubled.
28	Case Study: Search Results Surgeon General Call to Action The problem of overweight in children and adults The causes of overweight Determination of overweight in children and adolescents General suggestions Physical activity suggestions Healthful eating suggestions
29	Case Study Target audience: school nurses Prepare needs assessment Key elements Obesity in pediatric population is increasing. Obese children have higher risks for diabetes, high cholesterol, and high blood pressure. Obese children have a 70% chance of becoming obese adults. Causes of obesity in children include lack of physical activity, unhealthy eating patterns, or a combination. Reducing body weight by 5% to 10% can decrease medical risks and improve overall health.
30	The following resource information is available at our Web site www.iche.edu
31	Resources: Guidelines National Guideline Clearinghouse http://www.guideline.gov Initiative of the Agency for Healthcare Research and Quality, Department of Health and Human Services Free online access US Preventive Services Task Force (USPSTF) Recommendations http://www.arhq.gov/clinic/uspstfix.htm Recommendations for clinical preventive services based on reviews by USPSTF Free online access
32	Resources: Guidelines Institute for Clinical Systems Improvement (ICSI) http://www.ICSI.org Guidelines for preventive services and disease management ICSI is a nonprofit collaboration of health-care organizations, including Mayo Clinic Free online access
33	Resources: Guidelines CDC Wonder http://wonder.cdc.gov/ On-line public health information system Provides numbers and rates of sexually transmitted diseases, cancer cases, or deaths in the United States Demographic data (population, Data2010, Healthy People 2010), deaths (overall, occupational, fatal accidents), morbidity, disease, health promotion, sexually transmitted diseases, tuberculosis surveillance, babies, immunization, reports and recommendations, occupational safety Users request data for any disease and demographic group by submitting ad hoc queries against available datasets
34	Resources: Guidelines NIH Consensus Development Program (CDP) http://consensus.nih.gov/ Unbiased, independent, evidence-based assessment of complex medical issues Purpose of a CDP conference: Evaluate the available scientific information on a biomedical issue, and develop a statement that advances understanding of the issue under consideration and will be useful to health professionals and the public.
35	Resources: Journals ACP Journal Club http://www.acpjc.org/?hp Bimonthly clinical review journal ($78/year) American Family Physician http://www.aafp.org/afp Twice monthly clinical review journal POEMs, Cochrane for Clinicians Bandolier http://www.jr2.ox.ac.uk/bandolier Free on-line access Monthly journal providing summaries of searches of PubMed and Cochrane library for systematic reviews and meta-analyses The Journal of Family Practice http://www.jfponline.org Monthly journal
36	Resources: Journals ACP Journal Club http://www.acpjc.org/?hp Today's Featured Articles: 20 Jan 06 A sequential 10-day regimen was better than standard triple therapy for eradicating Helicobacter pylori in older patients Atorvastatin did not prevent cardiovascular events or death in patients with type 2 diabetes receiving hemodialysis Low-dose aspirin did not prevent cancer in healthy women Vitamin E did not prevent cardiovascular disease and cancer in healthy women Review: Vitamin D plus calcium, but not vitamin D alone, prevents osteoporotic fractures in older persons Review: Evidence of benefit for perioperative β-blockers in noncardiac surgery is unreliable A simple risk score predicted 7-day stroke risk after transient ischemic attack
37	Resources: Databases Clinical Evidence http://www.clinicalevidence.com Clinical reviewed, updated semi-annually Assembled by: http://www.unitedhealthfoundation Cochrane Database of Systematic Reviews http://www.cochrane.org/cochrane/revabstr/mainindex.htm Collection of systematic reviews Free online access York Database of Abstracts and Reviews of Effects (DARE) http://www.york.ac.uk/inst/crd/dare.htm Abstracts of systematic reviews Free on-line access
38	Resources: Databases Dynamed http://www.dynamedical.com Database of summaries of evidence from Clinical Evidence and Cochrane database $200/y on-line access First Consult http://firstconsult.com Database of summaries of evidence from Clinical Evidence, Cochrane databases and National Clearinghouse guidelines $149/year online access, CD, hard copy
39	Resources: Databases InfoRetriever http://www.infopoems.com Search engine with access to EBM resources POEMs (including daily POEM via e-mail), Cochrane, diagnostic test database $249/year online access, CD, or hard copy SUM Search http://sumsearch.uthscsa.edu Search engine gathering EBM information from Medline, DARE, and National Guidelines Clearinghouse Free online access
40	Resources: Databases TRIP Database (Turning Research Into Practice) http://www.tripdatabase.com Search engine gathering EBM information from Medline, DARE, and National Guidelines Clearinghouse Free online access PubMed Systemic Reviews http://www.ncbi.nlm.nih.gov PubMed Services, Clinical Queries, Systematic Reviews Citations of systematic reviews, reviews of clinical trials, consensus development, conferences, and guidelines Free online access
41	Resources: Clinical Trials and Alerts ClinicalTrials.gov http://www.clinicaltrials.gov Federally and privately sponsored clinical research in humans Free online access Clinical Alerts http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html Expedited release of findings of NIH-funded clinical trials when data influence morbidity and mortality Free online access
42	Resources: Clinical Trials and Alerts Center Watch Clinical Trials Listing Service http://www.centerwatch.com/patient/trials.htm Service to help patients find clinical trials PubMed Clinical Queries http://www.ncbi.nlm.nih.gov PubMed Services, Clinical Queries Identifies citations corresponding to specific clinical study categories
43	For more information, contact our Web site www.iche.edu
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