Funded by the Patient-Centered Outcomes Research Institute (PCORI, - - PowerPoint PPT Presentation

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Sep 05, 2023 139 likes •432 views

Funded by the Patient-Centered Outcomes Research Institute (PCORI, 1900-TMC) Principal Investigator: David M Kent, MD, MS, Director, Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health

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Funded by the Patient-Centered Outcomes Research Institute (PCORI, 1900-TMC) Principal Investigator: David M Kent, MD, MS, Director, Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center

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Information and comments you share will

 Be used for research only  Be treated confidentially  Not be attributed you or your organization

Please protect others in the discussion by not repeating anything you hear in a way that is attributable to a person or organization Keep in mind that PACE and Tufts Medical Center cannot guarantee that everything you say will be kept confidential by all of the participants

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We don't want to miss any of your comments.

 The recordings will be used to create de-

identified transcripts.

 After transcripts have been created, the

recordings will be destroyed. A summary article will be published.

 You will see the report before it is published.  Only aggregate results will be reported.  No information will be attributed to individuals.  Funder and public will not see who made

comments.

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 Take care of yourself & ask for what you need  Ask questions (some medical terms may be

unfamiliar)

 Step up, step back (draw out others’ ideas)  Agree to disagree  Acknowledge everyone’s experience is

different

 “One mic” (please mute phone when not

speaking)

 Others?

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David Tom

Tufts Medical Center RAND Corporation

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 What is your first name and where are you

from?

 Do you belong to any patient or health care

community?

 Tell us one interesting thing about yourself

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 Welcome and Introductions – 10 mins  Introduction to Evidence-based Medicine – 30 mins  How to apply clinical trial results and subgroup

analyses to individual patients – 30 mins

 Additional discussion – 15 mins  Final comments – 5 mins

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 Welcome and Introductions – 10 mins  Introduction to Evidence-based Medicine – 30 mins  How to apply clinical trial results and subgroup

analyses to individual patients – 30 mins

 Additional discussion – 15 mins  Final comments – 5 mins

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 the use of current best evidence in decisions

about the care of patients. - Sackett JAMA 1996

Traditional medicine: based on experience Evidence-based medicine: based on data

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“Michael and I combined for 57 points”

Bill Wennington, 1995

What is misleading about Bill’s statement?

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Harm Benefit

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HARM

ACTUAL OUTCOME COUNTER FACTUAL OUTCOME

HARM BENEFIT BENEFIT BENEFIT

Harm Benefit

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0 = alive 1 = dead

Without Treatment 1 1 1 1 1 1 1 1 1 1 1 With Treatment 1 1 1 1 1 1 1 1 1

Proportion 11/20 9/20 Dead (55%) (45%)

BENEFIT

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 Welcome and Introductions – 10 mins  Introduction to Evidence-based Medicine – 30 mins  How to apply clinical trial results and subgroup

analyses to individual patients – 30 mins

 Additional discussion – 15 mins  Final comments – 5 mins

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 Jane had a small stroke 1 month ago

45 year old female
No other major problems like diabetes
r high blood pressure

 Jane and her doctor are deciding on the best

treatment to prevent a future stroke

 Research says: on average, treatment A is

better than treatment B

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Should I start Treatment A?

Am I similar to the “average” person from the research study? Which treatment works best in patients like me?

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 Is the answer clear to you?  What would you recommend Jane do?

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 We already know, research says: on average,

treatment A is better than treatment B

 Subgroup analyses reveal that:

Treatment B is better than

treatment A for younger patients (less than age 50)

Treatment A works better than

treatment B for women

Treatment A works better than

treatment B for patients with normal blood pressure

Treatments A and B work about the

same for non-diabetics

Which treatment works best in patients like me?

Jane is

45 years old
Female
Had a small

stroke 1 month ago

Has no other

major problems

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Did subgroup information help you make a decision, or did it make your decision more difficult? Did subgroup information change your mind? What do you recommend Jane do?

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 Problems with overall results  Problems with subgroup analyses

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 Evidence comes from groups; decisions are

made by and for individuals

 Overall average results do not necessarily

apply to all patients

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 Traditional subgroup analysis compares

groups that differ only on a single factor

 Patients have many attributes

simultaneously

Not patient-centered, no person is one-factor
Testing many factors will result in some false-

positive associations (multiplicity)

Does not represent the full spectrum of patient

heterogeneity

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 Welcome and Introductions – 10 mins  Introduction to Evidence-based Medicine – 30 mins  How to apply clinical trial results and subgroup

analyses to individual patients – 30 mins

 Additional discussion – 15 mins  Final comments – 5 mins

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 What information can you recall needing to

make decisions about your care?

 If you asked a provider for more information:

How did you ask your question(s)?
Do you recall the answer(s) you got?

 How would you phrase these questions now?  Do you have any new questions about your care?

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 Welcome and Introductions – 10 mins  Introduction to Evidence-based Medicine – 30

mins

 How to apply clinical trial results and subgroup

analyses to individual patients – 30 mins

 Additional discussion – 15 mins  Final comments – 5 mins

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