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Health Care Administration and Policy

What is Evidence Based Practice (EBP)?

Evidence-Based Medicine [also referred to as Evidence-Based Practice] is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

Source: Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13; 312 (7023): 71-2.

Process

Ask a Question

  • Ask yourself the 5 W's and H: Who, What, Where, When, Why, and How?  (Who are the stakeholders? What is the issue/problem/concern/innovation? Where and When will it/does it occur?  Why is it important?  How will you propose to address it?)
  • Do background research to make sure you have a solid foundation.
  • Create a research question to guide your search.

Acquire Evidence - Search the Literature

  • Where will you search?
  • What types of studies or data will be most helpful in answering your question?

Appraise the Evidence

  • Critically appraise the evidence/research you found: what methodologies were used?  How was the data analyzed and reported?  Are the conclusions supported by the data?
  • Evaluate What You Find

Implement

  • Consider what the evidence means in your situation, related to your stakeholders and their needs, and how it may be best implemented.

Evaluate/Assess

  • How did it work?  Did you see results that created the outcomes you were trying to achieve?  Do you need to adjust the implementation?  Do you need a different solution?

Levels of Evidence

Melnyk Model (example pyramid below):
I. Systematic reviews or  meta-analyses of RCTs (randomized control trial).
II.  Well-designed RCTs
III. Well-designed, controlled trials without randomization
IV. Well-designed cohort and case-control studies
V. Systematic reviews of descriptive and qualitative studies
VI. Descriptive and qualitative studies
VII. Expert consensus reports

Melnyk model pyramid of evidence showing seven levels labeled I to VII from top to bottom.

Source: Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott, Williams & Wilkins.