Deborah S. Cummins, PhDSenior Director, Research & Evidence AnalysisResearch & Strategic Business DevelopmentAmerican Dietetic Association

November 2009

ADA Evidence Analysis Process

EAL® Home Page

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Online Resourcewith the bestavailable researchon importantdietetics topics in apractitioner-friendlyformat

www.adaevidencelibrary.com

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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

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©

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Steps in Evidence Analysis Process

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If appropriate, next phase:

•Write Position Paper

•Develop Guideline and Toolkit

Steps in EA ProcessSelect Topic

Appoint Expert Work Group

Define Questions

Determine Inclusion/Exclusion Criteria

Conduct Literature Review for Each Question

Analyze Articles / Critical Appraisal

Complete Overview Table and Evidence Summary

Develop Conclusion Statement

Reach Consensus on Grade

Publish to Online EAL

Steps in EA Process

Step 1:

Formulate the Question

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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

2009-2010

Chair: Sue Kent, MS, RD, LD

Vice Chair: Tamie M. Frable-Newman, MS, RD, LDN

Members:Linda Arpino, MA, RD, CDNChristina Biesemeier, MS, RD, LDN, FADAClaudia Conkin, MS, RD, LDErica Gradwell, MS, RDWahida Karmally, DrPH, RD, CDE, CLSPatti S. Landers, PhD, RD, LDAinsley Malone, MS, RD, LD, CNSD

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EBP Committee reports jointly to House of Delegates and Board of Directors

Evidence Based Practice Committee

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New LIBRARY Projects in 2009-10 (in RED)

Evidence Analysis Work Group

Steps in EA Process

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Step 2:

Gather and Classify the Research

Example: Question from AWM Work Group

How effective is the consumption of low glycemic index foods for reducing energy intake and promoting weight loss?

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Search Plan & Resultsfor each question

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Date of SearchInclusion Criteria:-Age-Setting (outpatient)-Sample Size-Acceptable dropout rate-Year Range-English LanguageDatabases SearchedSearch TermsList of Articles

ReportsInclusion& ExclusionCriteria

Steps in EA Process

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Step 3:

Critically Appraise Each Article

Literature Review

Q. Who creates the sort list?

A. Project Lead Analyst and ADA Librarian

Q. Who approves the sort list?

A. Expert Work Group

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Project Managers/Lead Analysts

Evidence Analysts

Search Plan & ResultsIncluded articles and Excluded articles (with reason)

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List Reason for exclusionFor each article notIncluded in the Analysis;e.g. Sample size Too small

The Worksheet

A worksheet and quality criteria checklist is created for each article

• Responsibility of analyst• Reviewed by lead analyst• Approved by workgroup

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Example: Worksheet

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•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

Example: Quality Criteria Checklist

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Questions related to relevance and validity

Determines if article is rated as:

Positive QualityNegative QualityNeutral Quality

Steps in EA Process

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Step 4:

Summarize the Evidence in an Overview Table and Evidence Summary

Overview Table

List :

•Citation•Study Design•Quality Rating•Sample Size•Interventions and Outcomes

in table format to enable user to compare studies side by side.

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Narrative Evidence Summary

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Example: Summary of evidence for Low Glycemic Diets question

Evidence Summary - Bibliography

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Citations linked to worksheets at the bottom of the

Evidence Summary

Steps in EA Process

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Step 5:

Develop Conclusion Statement and Grade the Strength of the Supporting Evidence

Example: Conclusion Statement

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GradeEight randomized controlled trialsreport no significant differencesin energy intake or body weightafter the consumption of alow-glycemic index diet. Grade I

Explanation of Grades

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% of Grade I

questions on EAL

PUBLISH ON EAL®

Available free to All ADA Members Question Conclusion GradeEvidence SummaryOverview TableWorksheets and Quality Checklists for each articleSearch Plan & Results

Individual EAL Subscriptions are available from www.adaevidencelibrary.com Store

For Institutional EAL subscriptions, contact khowarter@eatright.org

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Abstracted Articles/Worksheets

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How much content is on EAL®?

EAL® Usage

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EAL Launched Sept 2004

Overall Total Page

Views 9/2004 – 11/2009:

7 Million +7,091,411

EAL Usage Worldwide

Users from 191 different countries

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Guideline Development

Steps in the EA Process

Annual review of Evidence Analysis Guideline Projects

ReviewRe-run searches for each questionDetermine if revision is neededDocument date of review

Revise“Revise” using EA ProcessUpdate rating of conclusion statements/recommendations as needed

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Summary

ADA’s Evidence Analysis Library can be found at www.adaevidencelibrary.com

Questions contact: eal@adaevidencelibrary.com

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ResourcesCheck Resources on EAL for additional PowerPoint presentations.

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