Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

Cost-Effectiveness of Field Trauma Triage among Injured Adults Served by Emergency Medical Services

May. 25, 2016

Craig D Newgard, Zhuo Yang, Daniel Nishijima, K John McConnell, Stacy A Trent, James F Holmes, Mohamud Daya, N Clay Mann, Renee Y Hsia, Tom D Rea, N Ewen Wang, Kristan Staudenmayer, M. Kit Delgado

In the Journal of the American College of Surgeons, M. Kit Delgado and colleagues evaluate the cost-effectiveness of field trauma triage practices (the criteria used to decide whether to transport an injured patient to a major trauma center). The authors compare current triage practices with alternatives that meet national policy benchmarks set by the American College of Surgeons Committee on Trauma (a high-sensitivity field triage strategy that would miss no more than 5% of seriously injured patients) and a moderate sensitivity, high-specificity approach (in which at least 65% of...

Economic Evaluations of Opioid Use Disorder Interventions

Apr. 22, 2016

Sean Murphy, Daniel Polsky

In PharmacoEconomics, Sean Murphy and Daniel Polsky review the literature on economic evaluations of opioid use disorder interventions. Evidence of effectiveness does not always lead to adoption of a given therapy. Economic evaluations can provide evidence that will help stakeholders efficiently allocate their resources. Murphy and Polsky conducted a systemic review of major electronic databases from inception until 2015. Forty-nine studies were included in the study. They find that the economic literature on methadone maintenance therapy (MMT) supports previous findings that MMT...

The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices

Mar. 29, 2016

Rebecca Stewart, Danielle Adams, David Mandell, Trevor Hadley, Arthur Evans, Ronnie Rubin, Joan Erney, Geoffrey Neimark, Matthew Hurford, Rinad Beidas

In Psychiatric Services, Rebecca Stewart and colleagues, including David Mandell, Trevor Hadley and Rinad Beidas examine how financial factors affect the implementation of evidence-based practices (EBPs) in a large urban publicly funded mental health system. They interviewed 33 agency leaders and 16 policymakers, who described financial distress in community mental health agencies, and reported concerns about complex and expensive implementation of EBPs. These stakeholders agree that the cost of implementing EBPs should be shared between the agencies and the health system; however...

Evidence Synthesis Activities of a Hospital Evidence-Based Practice Center and Impact on Hospital Decision Making

Dec. 7, 2015

Kishore Jayakumar, Julia Lavenberg, Matthew Mitchell, Jalpa Doshi, Brian Leas, David Goldmann, Kendal Williams, Patrick Brennan, Craig Umscheid

In the Journal of Hospital Medicine, Kishore Jayakumar and colleagues, including Jalpa Doshi and Craig Umscheid, assess whether the evidence synthesized and locally disseminated by a hospital evidence-based practice center (EPC) impacts institutional decision-making. Looking at a large academic health care system, the authors examined the EPC’s database of systemic reviews and a survey on the EPC’s reports, which assessed them for their usability, impact and satisfaction. Of the 249 reviews completed by the EPC since its inception, the most common requests came from clinical...

Focused Cardiac Ultrasound in Place of Repeat Echocardiography: Reliability and Cost Implications

Oct. 1, 2015

Vinay Kini, Nidhi Mehta, Jeremy Mazurek, Victor Rerrari, Andrew Epstein, Peter Groeneveld, James Kirkpatrick

In the Journal of the American Society of Echocardiography, Vinay Kini and colleagues, including Andrew Epstein and Peter Groeneveld, assess the reliability and cost-effectiveness of using expert focused cardiac ultrasound (eFCU) in place of repeat transthoracic echocardiography (TTE). Rates of repeat TTE (two or more performed within 30 days) are high and can substantially increase the cost of providing cardiovascular care. The authors enrolled patients with prior TTE within 30 days who were ordered for another TTE. Participants underwent eFCU in addition to TTE and the study...