13 Considerations for Making an Evidence-Informed Decision

Thinking of purchasing or upgrading a medical technology? Are you changing service providers that will necessitate acquiring new equipment or resources? Will you be implementing a new quality improvement process that affects resources? You need more than manufacturer information and local expert opinion to be truly evidence-informed.

Consider these 13 questions before you say “yes.”

1. Why is this technology or change being considered now?

What are the drivers? Are these pressures direct or indirect, internal or external? What is the source and motivation for them? Is it the right time in the budget cycle for this purchase?

2. Is there enough quality evidence to support a proposal or business case?

Does your team agree? Consider seeking assistance from available resources like the local library, CADTH, or other research-based organizations to critically appraise the data you’ve found. CADTH’s Grey Matters: A Practical Tool for Searching Health-Related Grey Literature (www. cadth.ca/grey-matters) may be ideal for conducting your own search. Also, the Institute of Health Economics (www.ihe.ca) publishes Health Technology Assessment on the Net, which has a wealth of information.

3. What are the policy implications?

Is there alignment with regional and provincial priorities, and strategic organizational direction? How does the change you’re considering fit with provincial or regional services?

4. Is this a “want” versus an actual validated “need”?

Are you considering this technology or process because other provinces, cities, or service programs already have it or are promoting it? Are their demographics similar to yours? What gaps exist in your system that could benefit from this purchase, or is it an add-on? What are your local statistics telling you?

5. Will this change support patient- and family-centred care priorities?

Have you consulted with quality improvement or measurement services within your region, as well as patient councils or committees, to determine the value and perceived benefit of the change?

6. What’s the current availability and approved accessibility?

Have you checked that the technology is approved for sale in Canada? Refer to the Health Canada Medical Devices Active Licence Listing — MDALL — at www.hc-sc.gc.ca/dhp-mps/md-im/licen/mdlic-eng.php. CADTH can help you verify Health Canada authorization on short notice, if needed.

7. What have you learned from the previously published experiences of others?

Do you have an up-to-date literature search and summary on the proposed process or technology? Do the studies support your local context or fit with your health processes, standards of care, and quality improvement initiatives? How much can you extrapolate from research results to match your setting? CADTH can help with literature searching, summarizing, critically appraising, and with implementation. Our interactive workshops can provide you with self-reliance skills.

8. Is there potential for an unanticipated benefit?

Beyond your intended target program, patient group, or service, are there other groups who may benefit? What is your anticipated return on investment; for example: streamlined patient care, reduced wait times, improved patient health, improved quality of work and life, reduced health professional workload? What about demands on other services or service areas? How about indirect cost reductions?

9. Have you considered all direct and indirect costs associated with implementation?

What are the upfront costs for obtaining the technology or making the change? Is the technology evolving so quickly that regular upgrades will be necessary? Are there other costs (e.g., replacement cartridges, zeroing mechanisms, software upgrades, training, availability of experts, accreditation standards, evaluation processes) to consider?

10. What is your proposed implementation plan?

Do you need to write a formal business case to request funds? Will it be a phased approach, or a sudden introduction? Will different facilities within a region be able to equally access the technology? What additional resources, patient education materials, or staff training will you need? CADTH may be able to assist in providing evidence-informed support or locating existing materials. CADTH’s Knowledge Mobilization and Liaison Officer team can also assist you with business case writing.

11. Has an evaluation of practical human factor usability been established for consistent and easy usage?

How do you know that all those affected will readily understand, easily use, and evaluate the effectiveness of the changes or technology you are proposing? What published data are available to verify human usability? The University Health Network (www.uhn.ca) may be able to help. CADTH may also be able to assist in identifying other organizations that can share their experiences.

12. What is your evaluation plan to determine if the change will meet expectations?

For example, have you considered a quality improvement cycle, such as the PDSA? Have you considered a time frame? How will you know that a change has occurred and that it supports your ultimate goal? Have you established links to the LEAN process, or any other system or health quality improvement initiative?

13. Have you considered publishing and sharing your experience to benefit others facing this decision in the future?

Consider sharing your experiences so others may learn and benefit: publish in a journal, or present a poster or presentation at a conference like the annual CADTH Symposium — a venue attended by various government policy- and decision-makers.

Adapted from original work by D. Juzwishin (AHFMR) and B. Ens (CADTH) for use at Ministry of Health workshops in Saskatchewan (January 2008).