Transcript What is Evidence Based Practice

What is Evidence Based
Practice
Barbara Ann M. Messina, PhD, RN, ANP
Clinical Associate Professor
School of Nursing – Department of Adult Health
Adjunct Clinical Associate Professor
School of Medicine – Department Pharmacology
Objectives
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Define what is evidence based practice (EBP).
Discuss the history of EBP.
Implementing Evidence-Based Practice: The Iowa Model.
Discuss the Determination of Clinical Relevance in EPB.
Discuss how to Framing a Clinical Question using the PICO
model.
Discuss the Literature Review and Search Techniques.
Define the AHRQ.
What is EBP?
The use of evidence-based practice (EBP) and national guidelines
to improve the quality of patient care. EBP closes the gap
between research outcomes and practice (Newhouse, Dearbolt,
Poe, Pugh, & White, 2005)
What is EBP?
EBP uses current research evidence combined with clinical expertise
and patient values to formulate sound interventions (DiCenso, Guyatt,
& Clinska, 2005).
History of EBP
FFCM (1909-1988) in 1972. Dr. Cochran, a British epidemiologist,
identified a gap between current practices and evidence-based
guidelines.
Implementing EBP:
The Iowa Model
The Iowa Model of EBP was developed by Marita G. Titler, PhD, RN,
FAAN, Director Nursing Research, Quality and Outcomes
Management, Department of Nursing Services and Patient Care,
University of Iowa Hospitals and Clinics, Iowa City, Iowa
Iowa Model:
Considers the entire health care system:
 Provider
 Patient
 Infrastructure
Iowa Model
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Identify a trigger – problem focused or knowledge focused
Determine clinical relevance – is it important to the organization or
culture
Framing the Clinical Question
What to include what to exclude?
PICO Model
P = Who is the Patient Population?
I = What is the potential Intervention or area of Interest?
C = Is there a Comparison intervention or Control group?
O= What is the desired Outcome?
Your question drives your research!
The Literature Review
• Cochrane Library
• Clinical Practice Guidelines
• Cumulative Index to Nursing and Allied Health Literature (CINAHL);
and
• PubMed.
http://www.hsclib.sunysb.edu/
Types of Literature Reviews
Systematic Review: Looks for similar Studies (Critiquing an Article)
Meta Analysis: Statistical technique for
averaging an effect of treatment across
studies (Cochrane Data Base)
Levels of Evidence
Hierarchy of Evidence
Hierarchy of Evidence
Levels of Evidence
Category I: Evidence from at least one properly randomized controlled
trial.
Category II-1: Evidence from well-designed controlled trials without
randomization.
Category II-2: Evidence from well-designed cohort or case-control
analytic studies, preferably from more than one center or
research group.
Category II-3: Evidence from multiple times series with or without
intervention or dramatic results in uncontrolled
experiments such as the results of the introduction of
penicillin treatment in the 1940s.
Category III: Opinions of respected authorities, based on clinical
experience, descriptive studies and case reports
Hierarchy of Evidence
Hierarchy of Evidence
Evaluating Evidence
EBP
(Medicine)
United States:
Agency for Health Care Policy and Research (AHCPR)
• Department of Health & Human Services
http://www.ahcpr.gov/
• Developed many clinical guidelines to direct the EBM
movement.
GUIDELINE TITLE
Evidence-based practice guideline.
Exercise promotion:
walking in elders.
• BIBLIOGRAPHIC SOURCE(S)
Jitramontree N. Evidence-based practice
guideline. Exercise promotion: walking in elders.
Iowa City (IA): University of Iowa Gerontological Nursing
Interventions Research Center, Research Dissemination Core; 2007
Jun. 57 p. [95 references]
GUIDELINE STATUS
This is the current release of the guideline.
This guideline updates a previous version: Jitramontree N. Evidence-based
protocol. Exercise promotion: walking in elders. Iowa City (IA): University of
Iowa Gerontological Nursing Interventions Research Center, Research
Dissemination Core; 2001 Feb. 53 p.
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10948&nbr=5728
References
Ackermann, R.T. & Williams, J.W. (2002). Rational treatment choices for
non-major depressions in primary care: an evidence-based review.
Journal of General Internal Medicine, 17, 293-301.
American Psychiatric Association (2000). Diagnostic and Statistical
Manual of Mental Disorders (Rev. ed.) (4th ed.). (DSM-IVTR).
Washington, DC: American Psychiatric Association.
Balas, E. & Boren, S. (2000). Managing clinical knowledge for health care
improvement. In J. Bemmel & A.T. McCray (ed.). In Yearbook of
Medical Informatics: Patient Centered Systems (pp. 65-70). Stuttgart,
Germany: Schattauer Verlagsgesellschaft.
Cliliska, D., Ciliska, D. , Pinelli, J., DiCenso, A., Cullum, N. (2001).
Resources to enhance evidence-based nursing practice. American
Association of Critical Care Nurses: Advanced Practice in Acute and
Critical Care, 12(4), 520-528.
References
Collins, S., Vothe, T., DiCenso, A., Guyatt, G. (2005). Finding the
evidence. In DiCenso, A., Guyatt, G., Clinska, D. (Eds). EvidenceBased Nursing: A Guide to Clinical Practice. PA: Elsevier; 2005
DiCenso, A., Guyatt,G., & Clinska, D. (Eds.). (2005). Evidence-Based
Nursing: A Guide to Clinical Practice. PA: Elsevier.
Fineout-Overholt E., Melynk, B. , Schultz, A. (2005). Transforming health
care from the inside out: Advancing evidence-based practice in the
21st century. Journal of Professional Nursing, 21, 335-344.
Glass, G.V. (Ed.) (1976). Evaluation Studies Review Annual, Vol. 1. Beverly
Hills:
SAGE Publications.
References
Gordis L. (2008). Epidemiology (4th ed.). PA: Elsevier-Saunders.
Lang, N.M., Hook, M.L., Akre, M.E., et al., (2006). Translating
knowledge-based nursing into referential and executable application
in an intelligent clinical information system. In Weaver, C., Delaney, C.,
Webber, P., Carr, R. (Eds.). Nursing and Informatics for the 21st
Century: An International Look at the Trends, Cases, and the Future
(pp. 291-304). Chicago: Healthcare Information and Management
Systems Society.
Malloch, K., Porter-O'Grady T. (2006). Introduction to Evidence-Based
Practice in Nursing and Health Care. Boston: Jones and Bartlett.
Melnyk, B. & Fineout-Overhold, E. (2005). Evidence-Based Practice in
Nursing and Healthcare: A Guide to Best Practice. PA: Lippincott,
Williams, & Wilkins.
References
Newhouse, R., Dearbolt, S., Poe, S., Pugh, L., & White , K. (2005).
Evidence-based practice: A practical approach to implementation.
Journal of Nursing Administration. 35, 35-40.
Pignone, M.P., Gaynes, B.N., Rushton, J.L., et al., (2002). Screening
for depression in adults: a summary of the evidence for the US
Preventive Services Task Force. Annals of Internal Medicine,136,
765-776
Simon, G.E. (2000). Long-term prognosis of depression in primary
care. Bull World Health Organization, 78:439-445.
Titler, M.G., Kleiber, C., Steelman, V.J., et al. (2001). The Iowa model
of evidence-based practice to promote quality care. Critical Care
Nurse Clinical North America. 13, 497-509.
References
Theroux, R. (2006). How to bring evidence into your practice. Association of
Women's Health, Obstetric and Neonatal Nurses Lifelines. 10, 244-249
US Preventive Services Task Force (May, 2002). Screening for Depression:
Recommendations and Rationale. Rockville, MD: Agency for Healthcare
Research and Quality. Retrieved August 13, 2008, from
http://www.ahrq.gov/clinic/pocketgd/gcps2c.htm