Crossing the evidence chasm: building evidence bridges from process changes to clinical outcomes.
OBJECTIVE
Although demand for information about the effectiveness and efficiency of health care information technology grows, large-scale resource-intensive randomized controlled trials of health care information technology remain impractical. New methods are needed to translate more commonly available clinical process measures into potential impact on clinical outcomes.


METHODS
The authors propose a method for building mathematical models based on published evidence that provides an evidence bridge between process changes and resulting clinical outcomes. This method combines tools from systematic review, influence diagramming, and health care simulations.


METHODS
The authors apply this method to create an evidence bridge between retinopathy screening rates and incidence of blindness in diabetic patients.


RESULTS
The resulting model uses changes in eye examination rates and other evidence-based population parameters to generate clinical outcomes and costs in a Markov model.


CONCLUSIONS
This method may serve as an alternative to more expensive study designs and provide useful estimates of the impact of health care information technology on clinical outcomes through changes in clinical process measures.
Kendrick
David C
DC
Center for Information Technology Leadership, Partners HealthCare System, Wellesley, MA 02481, USA.
Bu
Davis
D
Pan
Eric
E
Middleton
Blackford
B
D020811:Biomedical Technology; D001766:Blindness / Q000453:epidemiology* / Q000517:prevention & control; D048909:Diabetes Complications / Q000453:epidemiology* / Q000517:prevention & control; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D008490:Medical Informatics; D008962:Models, Theoretical; D010043:Outcome and Process Assessment, Health Care