Sharon Manson Singer, EvidenceNetwork.ca
          Steve Buist, Hamilton Spectator
                   Jennifer Verma, CHSRF
   Introduce EvidenceNetwork.ca
   Talk about the Hierarchy of Evidence
   What makes a good health story? A bad one?
   Top ten questions to ask of health experts
    about their research
   Where to go for data
   How to assess the quality of data
   Last word to you the audience
   EvidenceNetwork.ca links journalists with
    health policy experts to provide access to
    credible, evidence-based information.
   EvidenceNetwork.ca is a non-partisan, web-
    based project funded by the Canadian
   Institutes of Health Research and the
    Manitoba Health Research Council to make
    the
   latest evidence on controversial health policy
    issues available to the media.
   The Canadian Health Accord is scheduled for renegotiation
    in 2014. Canadians will have to make decisions about
    many complex health policy issues, including;

   •   Aging population impact
   •   Rising drug costs
   •   Health care accessibility
   •   Private sector financing/delivery
   •   User fees
   •   Sustainability of the healthcare system

   EvidenceNetwork.ca is committed to working with the
    media to build a healthy dialogue around Canadian
    healthcare.
Health Care Stories are Good for You
Health Care Stories are Good for You
   Systematic Review and       Strongest evidence –
    meta-analysis                only as good as the
   Use upper tier studies       underlying studies
    in a synthesis of
    research findings




Type of Study                Expected Results
   Randomized               Well designed with
    experiments               sufficient sample size

                             High quality source of
   Natural experiments       exogenous variation
                              generating comparison
                              group
                             Well designed pre and
                              post measures
                             Analytical techniques
                              are appropriate

Type of Study             How good is it?
   Some control in the        Limited source of
    assignment of               exogenous variables or
                                some control of selection
    treatment                   or process
                               Well designed pre and
                                post measures
                               Appropriate data with
                                large sample

                               Reasonable approach to
                                estimating
   Correlational studies       counterfactuals


Type of Study               How good is it?
   Studies without a             Credible case selection
                                   with explicit causal logic
    comparison group               model
                                  Quality outcome
                                   measures
                                  Collect feedback from
                                   participants on quality of
   Participant Satisfaction       intervention
                                  Respected individuals or
                                   organizations with
   Expert Opinions                explicit rationale for
                                   opinion

Type of Study                  How good is it?
   Exploratory case      Less credible or
    studies                explicit case selection
                           criteria, theory of
                           change or outcome
                           measure(s)




Type of Study          How good is it?
   www.EvidenceNetwork.ca

   Sharon Manson Singer, PhD
   smansonsinger@gmail.com
Steve Buist, Investigations Editor
         The Hamilton Spectator
Luigi Di Bella and the “miracle” cure for cancer

                 (Pulling for the underdog . . .)
Autism and the MMR vaccine

(Science is a lot easier if you just make it up . . .)
Multiple sclerosis and “liberation therapy”

(The underdog tale, with a modern-day social media
                                         twist . . .)
Climate change and the human touch

(What makes for a balanced story . . .)
Health Care Stories are Good for You
1. Who is conducting the science?
1.   Who is conducting the science?
2.   Who is paying for the research?
1.        Who is conducting the science?
2.        Who is paying for the research?
     3.    Who is paying the researcher?
1.   Who is conducting the science?
       2.    Who is paying for the research?
          3.  Who is paying the researcher?
4.   Where are the results being published?
1.   Who is conducting the science?
        2.    Who is paying for the research?
           3.  Who is paying the researcher?
4.   Where are the results being published?
5.   What was the population being tested?
6. What was the sample size?
6. What was the sample size?
7. How significant are the results?
6. What was the sample size?
          7. How significant are the results?
8. What do other people think, and do those
 people have their own conflicts of interest?
9. How do these results fit into the
 context of what’s already known?
9. How do these results fit into the context of
                       what’s already known?
  10. Are there opposing viewpoints and how
     much weight should those viewpoints be
                                         given?
Jenn Verma, Director,
Collaboration for Innovation and
                    Improvement
mythbusters
   USING EVIDENCE TO DEBUNK COMMON
  MISCONCEPTIONS IN CANADIAN HEALTHCARE




                                          31
32
THE LATEST RESEARCH SHOWS THAT
WE REALLY SHOULD DO SOMETHING
     WITH ALL THIS RESEARCH




                                 33
In a review of World Health Organization (WHO) and
World Bank recommendations on five topics
(contracting, healthcare financing, HHR, tuberculosis
control and tobacco control):
◦ 2/8 publications cited systematic reviews;
◦ 5/14 WHO and 2/7 World Bank recommendations
  were consistent with both the direction and nature
  of effect claims from systematic reviews.

                Hoffman SJ, Lavis JN, Bennett S. 2009. The use of research evidence in two
                     international organizations’ recommendations about health systems.
                                                             Healthcare Policy 9(1): 66-86.


                                                                                              34
Effective
        Focused on
        Population                            Accessible
          Health




                                                                  Adapted with permission from Health Quality Ontario
Appropriat
   ely                High-quality                         Safe
resourced                  and
                      performance
                     health systems

   Integrated                                       Equitable




                                                                  (2011)
                                        Patient-
                Efficient
                                        centred

                                                                                                   35
Select
                       Provincial                      Subject                   Non-
    F/P/T                                                                                           International
                     Health Quality                    Matter                jurisdictional
Jurisdictions                                                                                         Reporting
                       Councils                        Experts               Organizations
                                                                                                      Initiatives

                      NL Centre for Health                                    Canadian Institute
                                                     Canadian Institute                               National Quality
 P/T Ministries of        Information                                             for Health
                                                         for Health                                     Forum (US)
      Health                                                                     Information
                                                        Information
                       NB Health Council                                       Health Council of     Agency for Health
                                                    Institute for Clinical          Canada          Research and Quality
                                                     Evaluative Sciences       Canadian Patient             (US)
                       Commissaire à la
P/T Health Regions                                          (ON)                Safety Institute
                       santé et au bien-                                                             NHS Indicators for
                        être du Québec                Canadian Stroke              Canadian         Quality Improvement
                                                         Network              Partnership Against            (UK)
                         Health Quality                 Canadian                    Cancer                Australian
                            Ontario                   Cardiovascular                                   Commission on
 Statistics Canada                                                               Accreditation
                                                    Outcomes Research                               Quality and Safety in
                                                                                   Canada
                         MB Institute of                                                                 Health Care
                                                          Team
                         Patient Safety                                         Fraser Institute          Quality and
                                                     POWER Study (ON)          Ontario Hospital     Efficiency in Swedish
   Public Health         Health Quality                                                                  Health Care
                                                                                 Association
 Agency of Canada         Council SK                   Cardiac Care
                                                       Network (ON)            Heart and Stroke
                         Health Quality                                          Foundation                OECD
                                                     Collaboration for
                          Council AB                   Excellence in
                                                                              Canadian Diabetes
                                                     Healthcare Quality
  Health Canada                                                                  Association
                      BC Patient Safety and          Alberta Diabetes                                      RAND
                         Quality Council            Surveillance System       Cancer Care Ontario



                                              Adapted with permission from the Health Council of Canada (2011) 36
37
Health Indicators provide a Dashboard
for Health and Healthcare

They can let you know that things are
running smoothly.

They can alert you to problems that
may need attention.




                                        38
Interpreting Data…
   rising BMI (Body Mass Index) doesn’t explain the root
    cause of weight gain.
   In 2009, Canadians received 121 CT scans per 1000
    people. There were also 8 MRI units per million
    population (vs. 12 MRI units per million as the OECD
    average). OECD (2011) reports Canada is “lagging
    behind,” but there is no agreed-upon benchmark.
   In 2009, Canada had 2.4 physicians per 1000 population
    (vs. 3.1 OECD avg), but…
    ◦ We have more physicians than ever before – Is this about supply or
      distribution and deployment?
    ◦ We also have more nurses per 1000 people (9.4 in Canada vs. 8.4
      OECD avg)

                                                                           39
   Comparing apples-to-apples?
    ◦ Age standardization
    ◦ Risk adjustment
   Measuring intangibles
    ◦ e.g., quality of life
    ◦ Composite indicators




                                  40
41
Lavis J. et al. 2009. SUPPORT Tools for evidence-informed health
     Policymaking (STP). Health Research Policy & Systems 7(Suppl 1).
             http://www.health-policysystems.com/content/7/S1/I1




42
“Numbers can’t ‘talk’ but they can
  tell you as much as your human
sources can. But just like with human
  sources, you have to ask” (Niles, 2007).

Niles R. 2007. Statistics every writer should know: A simple guide to understanding basic statistics, for
journalists and other writers who might not know math. http://nilesonline.com/stats/




                                                                                                            43
Support Tools for Policy Making
http://www.chsrf.ca/PublicationsAndResources/Research
         Reports/Support_Tools_for_Policy-Making.aspx


       Mythbusters
       http://www.chsrf.ca/PublicationsAndResources/
       Mythbusters.aspx

                                             What If?
http://www.chsrf.ca/Programs/HealthcareFinancingInnov
                   ationAndTransformation/WhatIf.aspx

 CHSRF’s Quality of Healthcare in Canada: A Chartbook (2010)
 CIHI’s Making Sense of Health Indicators (2011)
 HCC’s A Citizen’s Guide to Health Indicators (2011)
 CIHI’s Making Sense of Health Rankings (2008)
 OECD’s Health Data 2011: How Does Canada Compare? (2011)      44

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Health Care Stories are Good for You

  • 1. Sharon Manson Singer, EvidenceNetwork.ca Steve Buist, Hamilton Spectator Jennifer Verma, CHSRF
  • 2. Introduce EvidenceNetwork.ca  Talk about the Hierarchy of Evidence  What makes a good health story? A bad one?  Top ten questions to ask of health experts about their research  Where to go for data  How to assess the quality of data  Last word to you the audience
  • 3. EvidenceNetwork.ca links journalists with health policy experts to provide access to credible, evidence-based information.
  • 4. EvidenceNetwork.ca is a non-partisan, web- based project funded by the Canadian  Institutes of Health Research and the Manitoba Health Research Council to make the  latest evidence on controversial health policy issues available to the media.
  • 5. The Canadian Health Accord is scheduled for renegotiation in 2014. Canadians will have to make decisions about many complex health policy issues, including;  • Aging population impact  • Rising drug costs  • Health care accessibility  • Private sector financing/delivery  • User fees  • Sustainability of the healthcare system  EvidenceNetwork.ca is committed to working with the media to build a healthy dialogue around Canadian healthcare.
  • 8. Systematic Review and  Strongest evidence – meta-analysis only as good as the  Use upper tier studies underlying studies in a synthesis of research findings Type of Study Expected Results
  • 9. Randomized  Well designed with experiments sufficient sample size  High quality source of  Natural experiments exogenous variation generating comparison group  Well designed pre and post measures  Analytical techniques are appropriate Type of Study How good is it?
  • 10. Some control in the  Limited source of assignment of exogenous variables or some control of selection treatment or process  Well designed pre and post measures  Appropriate data with large sample  Reasonable approach to estimating  Correlational studies counterfactuals Type of Study How good is it?
  • 11. Studies without a  Credible case selection with explicit causal logic comparison group model  Quality outcome measures  Collect feedback from participants on quality of  Participant Satisfaction intervention  Respected individuals or organizations with  Expert Opinions explicit rationale for opinion Type of Study How good is it?
  • 12. Exploratory case  Less credible or studies explicit case selection criteria, theory of change or outcome measure(s) Type of Study How good is it?
  • 13. www.EvidenceNetwork.ca  Sharon Manson Singer, PhD  [email protected]
  • 14. Steve Buist, Investigations Editor The Hamilton Spectator
  • 15. Luigi Di Bella and the “miracle” cure for cancer (Pulling for the underdog . . .)
  • 16. Autism and the MMR vaccine (Science is a lot easier if you just make it up . . .)
  • 17. Multiple sclerosis and “liberation therapy” (The underdog tale, with a modern-day social media twist . . .)
  • 18. Climate change and the human touch (What makes for a balanced story . . .)
  • 20. 1. Who is conducting the science?
  • 21. 1. Who is conducting the science? 2. Who is paying for the research?
  • 22. 1. Who is conducting the science? 2. Who is paying for the research? 3. Who is paying the researcher?
  • 23. 1. Who is conducting the science? 2. Who is paying for the research? 3. Who is paying the researcher? 4. Where are the results being published?
  • 24. 1. Who is conducting the science? 2. Who is paying for the research? 3. Who is paying the researcher? 4. Where are the results being published? 5. What was the population being tested?
  • 25. 6. What was the sample size?
  • 26. 6. What was the sample size? 7. How significant are the results?
  • 27. 6. What was the sample size? 7. How significant are the results? 8. What do other people think, and do those people have their own conflicts of interest?
  • 28. 9. How do these results fit into the context of what’s already known?
  • 29. 9. How do these results fit into the context of what’s already known? 10. Are there opposing viewpoints and how much weight should those viewpoints be given?
  • 30. Jenn Verma, Director, Collaboration for Innovation and Improvement
  • 31. mythbusters USING EVIDENCE TO DEBUNK COMMON MISCONCEPTIONS IN CANADIAN HEALTHCARE 31
  • 32. 32
  • 33. THE LATEST RESEARCH SHOWS THAT WE REALLY SHOULD DO SOMETHING WITH ALL THIS RESEARCH 33
  • 34. In a review of World Health Organization (WHO) and World Bank recommendations on five topics (contracting, healthcare financing, HHR, tuberculosis control and tobacco control): ◦ 2/8 publications cited systematic reviews; ◦ 5/14 WHO and 2/7 World Bank recommendations were consistent with both the direction and nature of effect claims from systematic reviews. Hoffman SJ, Lavis JN, Bennett S. 2009. The use of research evidence in two international organizations’ recommendations about health systems. Healthcare Policy 9(1): 66-86. 34
  • 35. Effective Focused on Population Accessible Health Adapted with permission from Health Quality Ontario Appropriat ely High-quality Safe resourced and performance health systems Integrated Equitable (2011) Patient- Efficient centred 35
  • 36. Select Provincial Subject Non- F/P/T International Health Quality Matter jurisdictional Jurisdictions Reporting Councils Experts Organizations Initiatives NL Centre for Health Canadian Institute Canadian Institute National Quality P/T Ministries of Information for Health for Health Forum (US) Health Information Information NB Health Council Health Council of Agency for Health Institute for Clinical Canada Research and Quality Evaluative Sciences Canadian Patient (US) Commissaire à la P/T Health Regions (ON) Safety Institute santé et au bien- NHS Indicators for être du Québec Canadian Stroke Canadian Quality Improvement Network Partnership Against (UK) Health Quality Canadian Cancer Australian Ontario Cardiovascular Commission on Statistics Canada Accreditation Outcomes Research Quality and Safety in Canada MB Institute of Health Care Team Patient Safety Fraser Institute Quality and POWER Study (ON) Ontario Hospital Efficiency in Swedish Public Health Health Quality Health Care Association Agency of Canada Council SK Cardiac Care Network (ON) Heart and Stroke Health Quality Foundation OECD Collaboration for Council AB Excellence in Canadian Diabetes Healthcare Quality Health Canada Association BC Patient Safety and Alberta Diabetes RAND Quality Council Surveillance System Cancer Care Ontario Adapted with permission from the Health Council of Canada (2011) 36
  • 37. 37
  • 38. Health Indicators provide a Dashboard for Health and Healthcare They can let you know that things are running smoothly. They can alert you to problems that may need attention. 38
  • 39. Interpreting Data…  rising BMI (Body Mass Index) doesn’t explain the root cause of weight gain.  In 2009, Canadians received 121 CT scans per 1000 people. There were also 8 MRI units per million population (vs. 12 MRI units per million as the OECD average). OECD (2011) reports Canada is “lagging behind,” but there is no agreed-upon benchmark.  In 2009, Canada had 2.4 physicians per 1000 population (vs. 3.1 OECD avg), but… ◦ We have more physicians than ever before – Is this about supply or distribution and deployment? ◦ We also have more nurses per 1000 people (9.4 in Canada vs. 8.4 OECD avg) 39
  • 40. Comparing apples-to-apples? ◦ Age standardization ◦ Risk adjustment  Measuring intangibles ◦ e.g., quality of life ◦ Composite indicators 40
  • 41. 41
  • 42. Lavis J. et al. 2009. SUPPORT Tools for evidence-informed health Policymaking (STP). Health Research Policy & Systems 7(Suppl 1). http://www.health-policysystems.com/content/7/S1/I1 42
  • 43. “Numbers can’t ‘talk’ but they can tell you as much as your human sources can. But just like with human sources, you have to ask” (Niles, 2007). Niles R. 2007. Statistics every writer should know: A simple guide to understanding basic statistics, for journalists and other writers who might not know math. http://nilesonline.com/stats/ 43
  • 44. Support Tools for Policy Making http://www.chsrf.ca/PublicationsAndResources/Research Reports/Support_Tools_for_Policy-Making.aspx Mythbusters http://www.chsrf.ca/PublicationsAndResources/ Mythbusters.aspx What If? http://www.chsrf.ca/Programs/HealthcareFinancingInnov ationAndTransformation/WhatIf.aspx CHSRF’s Quality of Healthcare in Canada: A Chartbook (2010) CIHI’s Making Sense of Health Indicators (2011) HCC’s A Citizen’s Guide to Health Indicators (2011) CIHI’s Making Sense of Health Rankings (2008) OECD’s Health Data 2011: How Does Canada Compare? (2011) 44