The Institute aims to improve health care by better understanding the causes of, and solutions to, gaps between research evidence and its application in practice.

Accelerated automated systematic reviews that provide a concise summary of evidence to answer specific questions.

What is shared decision making and why is it important?

Overuse of low-value healthcare and underuse of effective healthcare are deeply entrenched. Both represent suboptimal care. Their drivers include: cognitive biases, poor communication, knowledge uncertainty, and structural and financial elements of health systems. Health systems are now striving to provide appropriate care, which can be described as care that is patient-centred and where the benefits and harms are weighed up and informed by evidence.

A key strategy to achieving this is shared decision making - a process which enables patients to make evidence-informed health decisions that are congruent with their values and preferences, after collaborative deliberation with their clinician. Genuine patient involvement in making informed health decisions is a fundamental right. As well as benefiting individual patients and clinicians, shared decision making holds promise for protecting and improving the health of populations and contributing to health system sustainability by reducing the overuse of ineffective tests and treatments and increasing the uptake of effective ones. It is a key component of most healthcare reform models and policies to emerge in recent years. Strategies that can be used to facilitate shared decision making include the use of patient decision aids, clinician training, and the integration of shared decision making tools into evidence syntheses such as guidelines.

Research activities of the Centre for Evidence-Informed Health Decisions include the development and dissemination of patient decision aids and the development of online and interactive training courses in shared decision making. These courses enable clinicians of any discipline to complete an accredited training activity at a time and location that is convenient to them – thus overcoming some of the barriers to shared decision making uptake. The courses have been adopted by health organisations and various speciality colleges throughout Australia and the United Kingdom.

 

New reform aims to prevent overdiagnosis and stop defining healthy people as diseased. Overdiagnosis can happen when the definitions of diseases are broadened so much that people with very mild problems, or people at very low risk of future illness, are classified as being sick, given a label, and then offered treatments which may do more harm than good.

Examples of the problem of inappropriately expanded definitions of disease include:

  • The controversial definition of Chronic Kidney Disease, which labels many older people who will never experience related symptoms, was launched at a meeting sponsored by a drug company
  • A vastly expanded definition of Gestational Diabetes, which may now label up to one in five pregnant women, despite a lack of good evidence that the newly labelled women or their babies will gain meaningful benefits that outweigh potential harms
  • A proposal to expand the definition of High Blood Pressure, which would label one in every two adults in the US, but has been rejected by a family doctor organisation and others over concerns it may cause more harm than good to many people
  • The creation of “pre-diseases” such as pre-osteoporosis, or pre-diabetes, which classify healthy people who are essentially “at risk of being at risk”.

What are we doing about it?

This new proposal recommends replacing existing panels with much more multi-disciplinary panels, with representatives from consumer/citizen organisations, led by generalists, with all members free of financial ties to pharmaceutical or other interested companies. It aims to change the rules for defining disease and setting thresholds for medical diagnoses.

Our work covers a wide range of services, programs and activities that address big, neglected problems in health care. The Institute delivers world-class research, engagement and training and serves as a national and international resource for health system leaders, industry partners, scholars, clinicians, patients and families in the implementation of evidence-based clinical care.

  • Evidence checks
    • Rapid automated systematic reviews that provide a concise summary of evidence to answer specific questions
  • Contract research
    • Research support services, expert panel review of research proposals  & evidence review of treatments
  • Advisory Services
    • Evidence-based practice advice to inform health service planning, reviews of guidelines and policies
  • Research & translation
    • Coaching and support services to develop and deliver research translation projects
  • Shared decision making
    • Developing and testing decision aids for patients and clinicians
  • Consumer Engagement
    • Facilitating community juries and consultations to help inform decisions and service planning
  • Minimising low value care
    • Preventing unnecessary treatments, maximizing the use of non-drug interventions and deprescribing at the end of life
  • Reducing overdiagnosis and overtreatment
    • Reducing unnecessary screening and testing & implementing evidence-based practice
       
  • Education
    • Tailoring education services to build research capacity

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