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About Clinical Consulting
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Research findings, no matter
how rigorously they are obtained and in which prestigious journal they are
published, may be evidence but are not an evidence base. Compiling an
evidence base requires the thoughtful and defensible integration of
studies into knowledge bases that
summarize,
specify and critique:
prior knowledge; study objectives, design, measurement, implementation,
and statistical analysis; strength of evidence; and accumulated evidence.
Only then can we start addressing the
so what,
what if, what next,
where from
and where to
questions - the translation of science back to clinical practice.
Clinicians like to
learn from clinical experience and their won application of evidence bases.
Clinicians like to see for themselves how advances in knowledge
impact on the care of their patients.
Patients are becoming informed consumers of healthcare. They
too want to know if
advances in healthcare will help them get better.
They hear and read about these new advances. Much of this information
is reliable, some of it is not. Increasingly, they too adopt a
micro-perspective: does it work for me?
Designing evidence-based
methods to support clinicians and patients in screening, monitoring, and
improving health - that is the focus of MATRIX45's
clinical consulting services.
Our clinical consulting
services
focus on this translation of scientific evidence, macro and micro, to
clinicians, patients, and families - to improve health care and patient
outcomes. On our clients' behalf, we synthesize macro-evidence,
develop guidelines, and communicate it all through various channels.
We apply macro-evidence into clinical support tools for use at the
point of care. Just as much, we help our clients develop processes
and systems to support the (responsible) use of micro-evidence:
screening, monitoring, risk assessment and profiling, outcomes evaluation,
and benchmarking. At MATRIX45,
we have some neat ideas and approaches as
to how this can be achieved.
At MATRIX45,
we take our clinical
consulting services to the next level. What are the real world
practice patterns in treating particular disease processes? What are
the associated patient outcomes? Using methods for pattern
recognition, risk adjustment, and causal modeling, can links between
variability in practices and variability in patient outcomes be
established?
Clients also ask for our
help in synthesizing research for their internal purposes:
state-of-the-science assessment, gap analysis, science-driven market
positioning, product differentiation, and portfolio analysis.
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Micro- And Macro-Levels of Evidence
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At MATRIX45,
we make a distinction between macro- and micro-evidence. We believe
that clinicians learn from both - and that quality improvement in clinical
practice is fueled by both.
Macro-evidence
is scientific knowledge generated through multi-center studies (trial as
well as non-trial designs) and the critical review of the findings of
these studies. It also encompasses the analysis and integration of
findings across studies into reviews, meta-analyses, and practice
guidelines. Clinical learning is channeled through publications,
conferences, and other education and communication methods.
Macro-evidence is about quality improvement by "seeing the larger picture"
- the "many-patients" picture.
Micro-evidence,
in contrast, is the evidence that comes from one's own clinical experience
and experimentation. It consists of the application of
macro-evidence in one's own clinical practice and "seeing with one's own
eyes" the impact of interventions on outcomes - the "my-patients" picture.
How can we design scientific
support programs to effect "behavioral change" in clinicians - their
adoption of good clinical practice patterns? It is critical to
provide clinicians and their teams with access to both levels of evidence
- not prescriptively ("thou shall ...") but intuitively ("what if ..."). ?
Let's extend this
macro/micro-evidence line of thought to patients and families.
Unfiltered access to medical information on the internet and in public
media, and the occasional informed
communication, are the macro-evidence available to patients and families.
The micro-evidence may be even more fragile and unreliable: Is this
treatment helping me? Do I feel less sick? Would I feel more
sick if I did not take my medications as the doctor prescribed? At
the patient and family level, the clinical challenge is to communicate
knowledge and foster experiential learning that encourages patient
responsibility and improves their persistence and compliance.
The litmus test for
evidence-based knowledge in healthcare is threefold:
Does the new knowledge find
its way into clinical practice: actively, through planned action;
passively, through diffusion and adoption?
Does it improve patient
outcomes?
Does real-world clinical
practice and achieved outcomes correspond to what is known to be best?
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CASE STUDIES |
Clinical consulting has figured
prominently in the principals' careers. Some examples (in the public
domain):
European Survey on Anaemia Management
Anemia and Blood Transfusion in Critically
Ill Patients
Building a Postmarketing Research Program on
Anemia Within and Across Disease and Treatment Processes
Geriatric Best
Practice Protocol Development and Hospital Performance Benchmarking
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European Survey on Anaemia Management
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A practice pattern and
outcomes analysis investigation, this project also sought to examine the
gap between actual clinical practice and evidence-based best practice
guidelines in managing anemia in patients with chronic renal failure.
Acclaimed as the first study to "put the scientific finger in the clinical
practice wound", its findings have been widely disseminated and are
frequently cited. There is strong anecdotal evidence of the impact of this
study on daily nephrology and dialysis practice (admittedly, hard data would be
helpful). The ESAM study was published in a special issue of
Nephrology Dialysis Transplantation.
Originally conducted in
Western Europe, this study was extended subsequently into Central and
Eastern Europe, Israel, the Middle East, North and South Africa,
Australia, West Asia, and Southeast Asia.
Clicking
here
will take you to an overview of the various articles and the option to
download *.pdf versions of each.
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Anemia and Blood Transfusion in Critically
Ill Patients |
What is the impact of
transfusion in anemic ICU patients (without acute bleeding)? We
worked with a team of academic investigators and biopharma staff on
designing and implementing a European-wide study on transfusion management
and associated morbidity and mortality outcomes: what are the practice
patterns in anemia/tranfusion management and can patient outcomes be
linked (causally) to these outcomes? Transfusion was clearly
associated with diminished organ function and 28-day mortality. The
study was published in the
Journal of the American Medical Association,
its relevance further underscored by the accompanying editorial by one of
the world's foremost transfusion specialists.
Click
here
to download a *.pdf version of the paper published in Journal of the
American Medical Association. Click
here for the accompanying editorial by Hébert and Fergusson in *.pdf.
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Building A Post-Marketing Research
Program on Anemia Within And Across Disease And Treatment ProcesseS |
As the prevalence and
consequences of anemia became better understood, a comprehensive
program of research was launched: across the full spectrum of chronic
kidney disease, and across disease states and/or treatments that
might induce anemia.
Within the spectrum of
chronic kidney disease, international studies were launched to assess
prevalence, determinants, practice patterns, and outcomes. Dialysis
patients were studied in the European Survey on Anaemia Management and its
global extensions (see above). Other
studies in the public domain focused on patients with early renal
insufficiency ("pre-dialysis") and patients who had undergone renal
transplantation. These studies were published in American Journal of
Kidney Diseases
(click
here for *.doc copy),
Nephrology Dialysis Transplantation
(click
here for *.pdf copy),
and American Journal of Transplantation
(click
here for *.pdf of
article and here for *.pdf of accompanying editorial).
The study on anaemia in
critically ill patients (see above) was
one in a series of studies on non-renal patients. A European study
focused on orthopedic patients undergoing total knee and/or total hip
arthroplasty and was published in Transfusion
(click
here for
*.pdf of article).
An
international study investigated disease-related and treatment-related
anemia in cancer patients, and initial findings are being released.
All of these studies
documented the persistent problem of underdiagnosis and undertreatment of
anemia - despite its well-known prevalence and consequences.
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Geriatric Best Practice Protocols And Hospital
Performance Benchmarking |
Since the early 1990s, we
have been involved in a nationwide effort to improve geriatric nursing
care in American hospitals through best practice protocol development and
hospital performance benchmarking. This collaboration with the John
A. Hartford Center for Geriatric Nursing at New York University has
engendered transformational change in over 130 hospitals and has
measurably impacted on staff knowledge and patient care delivery.
Please visit the Institute's website for
more information.
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Clinical Consulting Services |
Clinical research program
development and implementation
Clinical practice pattern
and outcomes analysis
Clinical practice guideline
development and evaluation
Clinical algorithm
development and evaluation
Review of scientific
literature and knowledge synthesis
Performance benchmarking
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