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The Importance of Evidence in a Learning Health System

Health Quality Ontario launches its new three-year plan for evidence-based recommendations and Quality Standards.

Our health care system is always evolving. Every day we see new diagnostic tests, new treatments, and new ways of providing care.

Everyone wants excellent care that works best for them. But it can get difficult when multiple options are available. For example: Let’s say your loved one was diagnosed with heart failure. You would want to know the best treatment for their individual situation. Is the newest option the best? In order to make decisions on care that are supported by the best available knowledge, clinicians often use a paradigm known as “evidence-based medicine” – an internationally recognized approach that has its roots here in Ontario at McMaster University.

Put simply, evidence-based medicine integrates the best research evidence with clinical expertise and patient values.

As an example of how evidence can change practice, this significant study recently published in the New England Journal of Medicine looked at commonly accepted guidelines for systolic blood pressure for patients with hypertension. Before, the recommendation was for systolic blood pressure to be 140 mm Hg or lower. But the results of this new study suggest that we can reduce the number of deaths from high blood pressure by aiming even lower, targeting under 120 mm Hg.

As a family doctor, I realize that not all patients will want to target a lower systolic blood pressure goal. The extra medications often required to bring someone’s blood pressure under 120 mm Hg might make a person feel too dizzy or increase the risk of falls. Some people may not be able to afford the medication; others simply may not want to take it. But because of this new evidence, the way I discuss the management of high blood pressure with my patients will change. This is where being patient-centered and clearly communicating the risks and benefits of a treatment option balances evidence with clinical expertise and patient values.

The principles of evidence-based medicine support our work in good quality improvement work. These principles push us to evaluate what we do, to be transparent with our results and to be prepared to change how we practice when evidence changes.

At Health Quality Ontario (HQO), as part of our commitment to better health for every Ontarian, we use rigorous scientific methods and consult with a variety of experts – including patients and caregivers – to identify, appraise and interpret the evidence for a wide range of health interventions. These include diagnostic tests, devices, procedures, and even health care programs and policies. We have an internationally respected advisory body – the Ontario Health Technology Advisory Committee, or OHTAC – that uses this information to make recommendations to the Minister of Health and Long-Term Care.

We now have a new plan to do even more. Excellence Through Evidence is our roadmap for how our evidence development efforts will evolve over the next three years. It aligns with and is captured in our strategic plan for HQO as a whole. It will guide our work related to evidence-based recommendations and our exciting new Quality Standards program.

We have already begun to strengthen and expand our work in this area. We are now developing our first three Quality Standards to improve care for individuals with schizophrenia, dementia and major depression. Each Quality Standard is a concise set of strong, evidence-based recommendations, paired with performance indicators. We will work with health system partners to develop and support the adoption of a growing range of Quality Standards in topic areas identified as high priorities for quality improvement in Ontario.

We will publish guides describing the detailed processes and methods we use to do our work. We will expand our output by collaborating with others and improving our own efficiency – I am pleased to note that we have already shortened the time it takes us to get to an OHTAC recommendation by four months. We will also create an online dashboard that tracks topics through our reviews and identifies follow-up actions taken on our published recommendations.

Working with our health system partners, we will expand our efforts to monitor and support the adoption of our recommendations. We will develop a strategy for producing new research that fills evidence gaps related to our recommendations. We will strengthen our partnerships with decision-makers, industry and above all else, we will more closely involve patients and caregivers in all of our work.

Finally, I want to note that we could not have created this plan without the input of many people. We consulted with our colleagues and partner organizations to ensure we were taking the right direction and we posted a draft for public comment on our website.

You can read the roadmap in detail here. Be sure to check back to our website often to let us know what you think about our latest evidence-based recommendations (to read and comment on our work, click here).

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