EVIDENCE BASED HEALTHCARE

Aarti SareenM.S.P.T.(Honours)

Evidence-based history• Evidence-based philosophies integrate a health

professional’s experience and knowledge with the best currently available clinical evidence.

• It was introduced as EBM by ACP Journal Club in 1991 and this editorial was the impetus for a a series called the Users’ Guides to the Medical Literature in order to help clinician decide how to incorporate these philosophies in to their daily practice.

Evidence-based evolution

Evidence-based medicine

Evidence-based librarianship

Evidence-based medical / health librarianship

Evidence-based health care, practice, dentistry, nursing etc.

Evidence based health care

• is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors

• Cochrane AL. Effectiveness and Efficiency : Random Reflections on Health Services. London: Nuffield Provincial Hospitals Trust, 1972. Reprinted in 1989 in association with the BMJ. Reprinted in 1999 for Nuffield Trust by the Royal Society of Medicine Press, London, ISBN 1-85315-394-X.

Health care professionals

• a person who by education, training, certification, or licensure is qualified to and is engaged in providing health care.

Why to go for evidence based health care

Knowing is not enough; we must applyWilling is not enough; we must do…..Goethe

Clinical Decisions• Achieving a diagnosis

• Estimating a prognosis

• Choosing to intervene

• Choosing an intervention

• Determining Harm

What kinds of clinical uncertainty do HCP face?

• Interventions– Therapy– Prevention– Targeting– Timing

• Diagnosis• Communicating risks and

benefits• Referral• Service Delivery/OrganisationOne choice every 10 minutes in

acute care

• Evidence based practice is followed to give/provide evidence based healthcare.

Evidence-based approach

1. Formation of a clinical question (s) (usually from an existing clinical scenario). It is formed using the following formula of PICO(T):

• Patient/population• Intervention • Comparison• Outcome• Time

PopulationWho are the relevant people?

Intervention

What are they exposed to?

Alternative or control intervention

Outcome (what are the person-level consequences we are

interested in?)

Evidence-based approach

2. A literature search to identify the evidence– Biomedical database searches, textbook searches,

grey literature, hand searching etc.

3. Critical Appraisal of the literature search results

4. Application of the results to the patient

5. Quality assurance of the previous steps

Poor quality and/or irrelevant research

The total body of research is distilled down to a conclusion based on the best available, reliable and relevant research

Example

In a 61 year-old women with osteoporosis (P), does the regular aerobic exercise versus exercise 4 times a week improve bone density and reduce the risk of fractures ?

Only approximately 10% of articles in the most prestigious internal

medicine journals can be regarded as “valid” and ready for application

Redesign the healthcare services

10 rules for redesigning health care

1. Care based on continuous healing relationships--care whenever its needed, not just through face to face visits2. Customization based on patient needs and values3. The patient as the source of control4. Shared knowledge and free flow of information5.Evidence based decision making6. Safety as a system property7. The need for transparency--all information available, including the system’s performance on safety, evidence based practice, and patient satisfaction8. Anticipation of needs

10 rules for redesigning health care

• 9. Continuous decrease in waste• 10. Cooperation among clinicians

Six challenges for health care organizations

• 1. Design seamless, coordinated care• 2. Make effective use of IT, including automating

patient records• 3. Manage knowledge so that it is delivered into

patient care• 4. Coordinate care across patient conditions,

services, and settings over time• 5. Advance the effectiveness of teams• 6. Incorporate measurement of care processes and

outcomes into daily practice

Getting evidence into health care delivery

1. Ongoing analysis and synthesis of medical evidence2. Delineation of guidelines3. Identification of best practices in design of care processes4. Better dissemination to professionals and public5. Decision support tools6. Goals for improvement7. Measures of quality for priority conditions