i. Definition
EPIC stands for Evidence-based Practice Identification and Change. It extends traditional health care quality improvement methods through i) use of existing evidence in the published literature; (ii) use of a benchmarked database to identify areas where practice outcomes are not comparable among participant agencies, and (iii) collaboration among a network of experts in clinical care,research and administration.
ii. Components
1. Preparation
During the preparation and baseline assessment phase of EPIC, key demographic,clinical practice, outcomes and process data are collected to develop benchmarks for outcome improvement. In-depth literature reviews and syntheses are then conducted to identify best practices. Practice issues at individual hospitals associated with good or poor outcomes are identified through statistical analysis to quantify their attributable risks. Multidisciplinary teams from hospitals are taught to examine the process of care and identify required changes. Practice changes are then designed to match the needs at individual hospitals for care improvement. A template for change is constructed and customized for each site.
2. Intervention
In the intervention phase of EPIC, site investigators and their EPIC research and clinical teams make changes to practices to address gaps between synthesized evidence and existing patterns of care. The Rapid Cycle Improvement Model is used to implant a new cycle every three months to make and monitor small gains rapidly. Feedback regarding progress of the efforts and resultant outcomes using visual presentations such as graphs is disseminated quarterly. Repeated cycles encourage re-appraisal, reinforce procedures, identify variation among results, and generate further change cycles.
3. Impact
EPIC has been shown to be effective in a cluster randomized trial involving 12neonatal intensive care units caring for a total of 7,484 infants to significantly reduce nosocomial infection and bronchopulmonary dysplasia.
iii. Epic and MORE OB
EPIC and MORE OB are interdisciplinary clinical programs that aim to improve practice through application of best evidence. Both rely on a community of practice model in which there is sharing of leaning and collective knowledge. The focus is on systems and institutional change.
- MORE OB presents workshops on a variety of clinical management issues in obstetrics. Participants are encouraged to anonymously report events that result in harm or could potentially lead to harm. These events are reviewed in detail from a systems approach to prevent their recurrence.
- EPIC focuses on cesarean section and related practices. Through study of variability in practice between institutions and factors associated with cesarean delivery within institutions, EPIC identifies those practice changes that may have an impact cesarean section. Practice change is based on review of evidence from systematic reviews of the particular practice selected for change. After implementation of change, Perinatal Services BC (formerly BCPHP) data is made available in rapid cycles to evaluate tie impact of that and subsequent changes on rates of cesarean birth and related intermediate factors.
