Evidence-based Medicine vs Evidence-based Practice
Evidence-based medicine (EBM) uses the most current and best evidence to administer care. Healthcare professionals, however, tend to use the term evidence-based practice because multiple disciplines are involved in healthcare delivery. It seems more appropriate to use this term in lieu of EBM from a quality perspective as well. Clinicians not only base their care on the experimental evidence but also consider experiential evidence, physiologic principles, patient and professional values, and system features in their decision making. This allows individualized application and dissemination of aggregate research evidence.
Measuring EBM Impact
Evidence-based practice promotes patient safety through the provision of effective and efficient healthcare, resulting in less variation in care and fewer unnecessary or nontherapeutic interventions. Outcome evaluation at the individual and aggregate level is an essential step in determining the impact of evidence-based practices. Evidence-based practice and outcomes measurement is iterative as the two work hand-in-hand facilitating one another.
Evidence-based Quality Management
Evidence-based quality management is based on two types of research—clinical and health services research. Clinical research evaluates the impact of interventions on patient outcomes. Outcomes measures typically include clinical outcomes, functional outcomes, and patient satisfaction. This type of research assists healthcare quality professionals in determining clinical evidence-based best practices. Health services research evaluates the health system at the micro and macro levels. Results from this type of research guide healthcare quality professionals in improving work processes and systems of care.
Rating Evidence-based Practices
The rating of evidence-based practices is often based on the U.S. Prevention Services Task Force (USPSTF) levels of evidence and grading system. The USPSTF is a group of independent experts in prevention and EBM that makes evidence-based recommendations about the clinical preventive services. Evidence for practice can be classified by certain levels or strength of evidence. The USPSTF also defined levels of certainty about net benefit. The USPSTF levels of evidence are often used to rate the evidence so that practitioners can make wide decisions about care and treatment options with some degree of certainty about outcomes. The levels are:
Low – the available evidence is insufficient to assess the effects on health outcomes.
Medium – The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is somewhat constrained.
High – The available evidence usually includes consistent results from well-designed, well-conducted studies in the representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Strong evidence is transformed into practice and then measured in standardized formats. Clinical guidelines are evidence-based care recommendations for defined populations and assist the clinician in decision-making regarding the patient care plan. Clinical pathways are used to implement the guidelines into practice and represent what has been determined to be the best evidence-based care for most patients. Clinical pathways are tools to manage quality outcomes and cost of care based on clinical guidelines and current evidence.
The 5 keys to employ evidence-based practices are:
1. Converting the need for information about prevention, diagnosis, prognosis, therapy, causation into an answerable question.
2. Tracking down the best evidence with which to answer that question.
3. Critically appraising that evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in own clinical practice).
4. Integrating the critical appraisal with clinical expertise and with the patient’s unique biology, values, and circumstances.
5. Evaluating the effectiveness and efficiency in executing the previous steps and seeking ways to improve them both for next time.