Posted:

A Q & A with Peter Wyer, MD

Peter Wyer, MD, is co-chair of the Academy Fellows’ Section on Evidence-Based Health Care and associate professor of medicine at Columbia University Medical Center 

Q: What is the work of the Fellows’ Section on Evidence-Based Health Care (SEBHC)?

A: SEBHC is a center for innovation and development in the field of evidence-based health care.  It sponsors a unique, multi-tiered and capacity-building summer program called “Teaching Evidence Assimilation for Collaborative Health Care (TEACH),” which attracts health professionals from all disciplines from all over the world. One of the activities of SEBHC is that it’s the secretariat for the North American Community of Guidelines International Network (GIN/NA). GIN is a non-profit membership organization that disseminates methodology, standards and expertise related to guideline development.

Since 2012 the section, with GIN/NA and other collaborators, have hosted the bi-annual, Evidence-based Guidelines Affecting Policy, Practice and Stakeholders (E-GAPPS) conference series.  Including patients in guideline development and implementation was a major theme of the 2015 conference.

Q: Tell me more about E-GAPPS and GIN?

A: As the first regional community within the GIN international organizations, GIN/NA  includes membership throughout North America including Mexico and Canada. SEBHC provides GIN/NA with logistical support, experience in organizing and running complex events and expertise in framing and developing the conceptual design of the E-GAPPS conferences. The relationship has made possible expanded awareness of GIN/NA and also a rapid expansion of the networks available to SEBHC and its ability to develop its collaborative agenda.

The E-GAPPS conferences offer forums for bringing timely themes and controversies before a diverse audience of stakeholders in the clinical guideline enterprise. The most recent E-GAPPS session brought together clinicians, health policy makers, care managers, and particularly patients whose care is increasingly shaped by clinical guidelines. You can View the March 2015 E-GAPPS materials or learn more about SEBHC at: ebmny@nyam.org

Q: How were health care consumers featured in the 2015 E-GAPPS conference?

A: Health care consumers attended the two-day event and served as plenary speakers, moderators and panelists (with the support of the Kaiser Family Foundation) SEBHC and GIN/NA partnered with Consumers United for Evidence-Based Healthcare (CUE), an independent organization that prepares consumers to participate effectively in guideline development to build the consumer presence.  CUE members engaged in a range of discussions, including collaboration across guideline efforts, shared decision-making, and other determinants of successful guideline adoption. 

“The patient voice is more important than it has ever been in modern health care … treatments have fundamentally changed with the movement to put the patient at the center of care,” said Mark J. Skinner, president and CEO of the Institute for Policy Advancement, Ltd. Skinner is a patient advocate and a member of the Patient Centered Outcomes Research Institute (PCORI) rare disease advisory panel at the March 2015 E-GAPPS session.

Sue Sheridan, director of Patient Engagement for PCORI, described how her personal experience as a mother of an infant who suffered brain damage from failure to recognize a severe form of neonatal jaundice led to a national effort to revise clinical guidelines for this condition.  Her alliance was joined by leading professional organizations and resulted in a uniquely patient-centered, widely-circulated guideline.

In his keynote address, Albert Mulley, MD, managing director, Global Health Care Delivery Science, The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, emphasized that failure to correctly identify patient preferences in the course of clinical decision-making is common and may result in harm comparable to medical errors. These perspectives highlighted the importance of finding an alternative approach to the narrow, medically driven, orientation that often characterizes guideline efforts.

Q: How does advancing guideline development relate to health reform and the Affordable Care Act?

A: Enhanced interest in the role of clinical guidelines in health care has emerged with the Affordable Care Act. In 2011, the National Academies of Science, Engineering, and Medicine (formerly the Institute of Medicine), released twin reports that defined new standards for clinical guidelines and for systematic reviews of research on the effectiveness of health care interventions. The National Academies report establishes the latter as a defining feature of what constitutes a guideline.

The National Guidelines Clearinghouse , the largest open access repository for clinical guidelines, has begun to incorporate these standards into its criteria for adding guidelines in its database. These developments have enhanced the relevance of the GIN/NA division to the North American health care community. The E-GAPPS conference series has received funding from the Agency for Healthcare Research and Quality and has included sessions for guideline developers and implementers on how to meet the new standards.  The consumer voice has played an important role in these sessions.

To learn more about the upcoming E-GAPPS conference (March 20-21, 2017), add your name to our mailing list. In 2017, conference speakers will continue to address the important issues related to consumer and stakeholder engagement in the clinical guideline process.