EVIDENCE BASED HEALTHCARE Aarti Sareen M.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 medicineEvidence-based health care, practice, dentistry, nursing etc. Evidence-based medical / health librarianship Evidence-based librarianship
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.
Knowing is not enough; wemust applyWilling is not enough; wemust 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/Organisation One 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
Outcome (what are the person- level consequences we are interested in?)
Evidence-based approach2. A literature search to identify the evidence– Biomedical database searches, textbook searches, grey literature, hand searching etc.3. Critical Appraisal of the literature searchresults4. Application of the results to the patient5. Quality assurance of the previous steps
The total body of research is distilled down to a conclusion based on the best available, reliable andPoor quality relevant researchand/orirrelevantresearch
ExampleIn a 61 year-old women with osteoporosis (P),does the regular aerobic exercise versusexercise 4 times a week improve bone densityand reduce the risk of fractures ?
Only approximately 10% of articles in the most prestigious internalmedicine journals can be regardedas “valid” and ready for application
10 rules for redesigning health care1. Care based on continuous healing relationships--carewhenever 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, includingthe 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 delivery1. 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
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