Evidence Analysis Process
Deborah S. Cummins, PhD
Nov. 8, 2006
Research: Foundation of the Dietetics Profession
EAL Home Page
www.adaevidencelibrary.com
Online Resource
with the best
available research
on important
dietetics topics in a
practitioner-friendly
format
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“Evidence-Based Dietetics Practice
is the use of systematically reviewed
scientific evidence in making food and
nutrition practice decisions
by integrating best available evidence with
professional expertise and client values to
improve outcomes.”
Definition developed by ADA Evidence-based Practice Committee with input from
Research Committee, Quality Management Committee, and Scope of Dietetics Practice
Task Force. Approved by ADA House of Delegates Leadership Team
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Why Evidence-based?
Improve quality of healthcare
Decrease wide variations in
practice
Reduce the gap between what
is known from research…and
what happens in real life
Take advantage of biomedical
knowledge
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Objectives
• Understand the Steps in the American
Dietetic Association’s Evidence Analysis
Process
• Identify topics and features in the ADA’s
Evidence Analysis Library
5
Resources
Check Resources on EAL for
additional PowerPoint
presentations.
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Steps in the
ADA
Evidence
Analysis
Process
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Steps in EA Process
• Select topic & Appoint expert working group
• Define questions and Determine inclusion/exclusion
criteria
• Conduct literature review for each question
• Analyze articles/ Critical appraisal
• Complete overview table and evidence summary
• Develop conclusion statement and reach consensus
on grade
• Publish to online EAL
• If appropriate, go to next phase: write position paper,
develop guideline & toolkit
• Review and Revise to keep information current
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Steps in the EA Process
1. Select Topic & Appoint Expert
Working Group
Responsibility of Evidencebased Practice Committee
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Structure of EBP Committee
• Joint HOD and BOD appointed committee
• Actively practicing in acute care, long-term
care, ambulatory care, and public health
• Trained as evidence analysts
• Representatives from QM, Research,
NCP/SL, DPBRN Committees and BOD
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Evidence-Based Practice
Committee 2006-2007
Marion Franz, MS, RD,
CDE (Chair)
Kathleen Niedert, MBA,
RD, LD, FADA (Vice
Chair)
Elvira Johnson, MS, RD,
CDE, LDN
Margie Tate, MS, RD
David Frankenfield, MS,
RD
Nancy Lewis, PhD, RD,
FADA
Kim Robien, PhD, RD,
FADA, CNSD
Rita Johnson, PhD, RD,
LDN, FADA
Trisha Furman, MS, RD,
LD, FADA
EBP Committee reports jointly to House of Delegates and Board of Directors
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Roles and Responsibilities of
EBP Committee
•
Oversee:
– Evidence analysis process and the Evidence Analysis
Library
– Development of Evidence-Based Guidelines and Toolkits
•
•
Promote the implementation of evidence-based
dietetic practice
Specific functions:
–
–
–
–
Appoint workgroup members
Prioritize evidence analysis projects
Determine format and content of products
Evaluate EA process
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Content published on EAL
HOD
BOD
Project is ongoing
Workgroup appointed
Evidence-Based Practice Committee
Adult
Weight
Management
Pediatric
Weight
Management
Measuring
Energy
Expenditure
Childhood
Overweight
Chronic
Kidney
Disease
Critical
Illness
Disorders
Of Lipid
Metabolism
Diabetes
1&2
Celiac
Disease
Gestational
Diabetes
Heart
Failure
Hypertension
Oncology
Spinal
Cord
Injury
Unintended
Weight
Loss
Non-nutritive
Sweetener
Nutrition
In Athletic
Performance
Fiber
Hydration
Nutrition
Counseling
HIV/AIDS
Bariatric
Surgery
Nutrition
New
topic?
Vegetarian
Nutrition
EBP Committee appoints an expert workgroup for each project.
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Expert Work Group
(6-8 persons for each project)
Experts in the field
– Appointed by EBP Committee
– Key functions:
• develop questions
• review materials (articles, worksheets, summaries)
• Formulate conclusion statements (answer to
question)
• Assign Grade to strength of the evidence
• Develop Guidelines, if appropriate
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Steps in the EA Process
2. Define Questions and
Determine Inclusion/
Exclusion Criteria
Responsibility of Expert Work Group
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Example: Question for evidence
analysis formulated by AWM workgroup
How effective is the consumption
of low glycemic index foods for
reducing energy intake and
promoting weight loss?
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Search Plan & Results
for each question Reports
Inclusion
& Exclusion
Criteria
Date of Search
Inclusion Criteria:
-Age
-Setting (outpatient)
-Sample Size
-Acceptable dropout rate
-Year Range
-English Language
Databases Searched
Search Terms
List of Articles
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Steps in the EA Process
3. Literature Review
• Creation of sort list: Responsibility
of Lead Analyst with ADA Librarian
• Approval of sort list:
Responsibility of Expert Work Group
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Evidence Analysts
–
–
–
–
Experts in critically analyzing articles
Must have at least Master’s degree; many have PhD’s
Trained at ADA’s EA workshop
Mentored by ADA Staff and Lead Analysts
– Read and analyze articles
•
•
•
•
Complete worksheets
Complete quality checklists
Complete overview tables
Complete evidence summaries
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Included articles and
Excluded articles (with reason)
List Reason for
exclusion
For each article not
Included in the
Analysis;
e.g. Sample size
Too small
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Steps in the EA Process
4. Critically appraise each article
Completion of worksheet and quality
criteria checklist
Responsibility of analyst
Reviewed by lead analyst
Approved by workgroup
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Example: Worksheet
•Citation / PubMed ID
•Date
•Study Design
•Class
•Rating (+/0/-)
•Research Purpose
•Inclusion Criteria
•Exclusion Criteria
•Description of Study
Protocol
•Data Collection
Summary
•Description of Actual
Data Sample
•Summary of Results
•Author Conclusion
•Reviewer Comments
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Example: Quality Criteria Checklist
Questions related
to relevance and
validity
Determines if
article is rated
as:
Positive Quality
Negative Quality
Neutral Quality
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Steps in the EA Process
5. Summarize the articles into an
overview table and a Narrative
evidence summary
Responsibility of analyst and lead analyst
Approved by workgroup
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Overview
Table
Low Glycemic Diets
Lists Citation, Study Design, Quality Rating, Sample Size, Interventions
and Outcomes in table format;– enables user to compare studies side by side
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Narrative Evidence Summary
Example: Summary of evidence for Low Glycemic Diets question
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Evidence Summary - bibliography
Citations linked to worksheets at the bottom of the Evidence Summary
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Steps in the EA Process
6. Develop Conclusion Statement
- the answer to the question –
and Assign Grade
Responsibility of Expert Work Group
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Example: Conclusion Statement
Grade
Eight randomized controlled trials
report no significant differences
in energy intake or body weight
after the consumption of a
low-glycemic index diet.
Grade I
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Explanation of Grades
% of Grade I
questions on EAL
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Steps in the EA Process
7. PUBLISH to ONLINE LIBRARY
(EAL)
Copyediting
Publish
Question, Conclusion, Grade, Evidence Summary, Overview Table,
Worksheets and Quality checklists for each article, and Search Plan &
Results all published together.
Available to all ADA members and EAL subscribers.
Responsibility of ADA Staff
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EAL Content Growth
comparison of Oct 15 2004 & Oct 15 2006
# of Projects on EAL
2006
17
2004
4
0
2
4
6
8
10
12
14
16
18
# of Worksheets on EAL
2006
1525
2004
118
0
200
400
600
800
1000
1200
1400
1600
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EAL Usage
(Number of pages viewed)
1000000
932207
EAL
Launched Sept 2004
800000
600000
400000
378216
200000
41392
0
04 005 006
0
2
2
2
Oct-Dec
2004
Jan-Dec
2005
Jan-Nov6
2006
Overall
Total Page
Views
9/2004 –
11/7/2006:
1 Million +
1,351,815
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EAL Usage Worldwide
Users from 114 different countries
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Steps in the EA Process
After publication of questions to online
library, there are 3 possible options.
• Project is concluded – or • Evidence analysis is incorporated into
an ADA Position Paper – or • Develop Guideline and Toolkit
(specific steps for guideline development can be found
in a companion presentation)
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Steps in the EA Process
Annual Review of Evidence Analysis
Guideline Projects
Review
•
re-run searches for each question
•
determine if revision is needed
•
document date of review
Revise
•
”revise” using EA process
•
Update rating of conclusion statements/recommendations as
needed
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Summary
• ADA’s Evidence Analysis Library can be
found at
www.adaevidencelibrary.com
• For questions contact:
eal@adaevidencelibrary.com
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