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Evidence-Based Practice

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This presentation provides a definition of evidence-based practice (EPB), its history, characteristics, and its application in various disciplines. The 5 steps of EBP are outline along with examples of evidence hierarchies.

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Evidence-Based Practice

  1. 1. Evidence-Based Practice Updated by Kristy Padron Original Content by Jennifer Boxen, Kristy Padron, and Tiffany Moxham for an FAU Libraries Lunch and Learn Session, March 2011.
  2. 2. • Define Evidence-Based Practice (EBP) and its characteristics. • Summarize the history of EBP. • Apply EBP to other disciplines. • Identify sources of evidence for various subject areas. Objectives
  3. 3. Definition of Evidence- Based Practice (EBP) Evidence-Based Practice (EBP) is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions (Sackett, Rosenberg, Gray, Haynes, & Richardson, 1996). A process that combines well-researched interventions with the following (National Association of Social Workers, 2018): • Clinical experience • Ethics • Patient/ client preferences • Culture
  4. 4. EBP is synonymous or similar to other terms in use: • Evidence-Based Practices • Evidence-Based Treatments • Evidence-Based Interventions • Evidence-Based Care • Evidence-Informed Interventions
  5. 5. History of EBP • EBP has its roots in Evidence Based Medicine (also referred to as Evidence–Based Health Care). • Created in the 1980s and popularized in the early 1990s: medical textbooks were unable to keep up with rapid changes in medicine, and were frequently based on the interpretations of a few people in a respective field. • At the same time, the medical literature in journals was being produced in record numbers, but was poorly organized.
  6. 6. History of EBP: Factors Influencing Its Use in Other Disciplines • “But it’s always been done this way”: health sciences (and others) realized many tasks and treatments were based on experience or routine rather than empirical proof. • Accountability: numerous accrediting agencies, organizations, government, and the public want to see that resources are going towards “what’s shown to work.” • Cost effectiveness: England’s NHS and presently, health insurance. • Multidisciplinary Teams: • Many problems or scenarios can improve their outcomes by having multidisciplinary teams work together. • Some problems are too complex for a single discipline to address.
  7. 7. Differences Between EBP and EBM • EBM/EBHC is primarily limited to the health care field and focuses on a specific patient or population. • EBP can be applied to many fields and is constantly being modified to best suit the subject where it is being applied.
  8. 8. The EBP Process: 5 Steps 1. Defining a question that needs to be answered. 2. Acquiring the literature that will be analyzed. (building and executing the search). 3. Critical appraisal: conducting a formal evaluation of the results (evidence, patient preferences). 4. Integrating the evaluated evidence into practice. 5. Re-evaluating the process to assess its efficacy and improve it in the future.
  9. 9. Defining the Question In EBM, a question is structured and defined in a specific way, referred to as a PICO question: This can be modified for EBP. P Patient/ Population/ Problem I Intervention (drug, diagnostic test, etc.) C Comparative Intervention O Outcomes (desired result)
  10. 10. Traditional EBM Question: In a 52-year old African American male with Type II diabetes, is metformin better than insulin at regulating blood sugar? (P) Patient/ Population/ Problem 52-year old African American Male Diabetes (I) Intervention (drug, diagnostic test, etc.) Metformin (C) Comparative Intervention Insulin (O) Outcome (desired result) Blood Sugar Levels
  11. 11. EBP Applied to Criminal Justice Is re-entry programming more effective than participation in corrections education programs in reducing recidivism among people released from prison? (P) Population/ Problem Prisoners or Inmates Recidivism (I) Intervention (drug, diagnostic test, etc.) Re-entry Programming (C) Comparative Intervention Corrections Education Programs (O) Outcome (desired result) Decreased Recidivism
  12. 12. EBP Applied to Library Settings In a library with a decreased budget, which is more effective: a self-checkout machine or a check-out desk for borrowing books? (P) Population/ Problem Library Decreased Budget (I) Intervention (drug, diagnostic test, etc.) Self Check-out Machine (C) Comparative Intervention Check-out Desk (O) Outcome (desired result) Cost Effectiveness
  13. 13. When To Apply EBP Background Questions: the need is to define some concepts, and not to compare interventions. • What are some good strategies of increasing parental involvement in an elementary school? Factual Questions: the need is to identify some facts that do not necessarily come from higher levels of research. • What was the population of Palm Beach County in 20? Too Few Studies: utilizing EBP is difficult if little has been published on a research question. • Is the use of herbal remedies for pain management during childbirth more effective than conventional medicine in Haitian communities?
  14. 14. Critical Appraisal Definition: the process of carefully and systematically examining research to judge its validity, reliability, and relevance to a particular context. Considerations in Critical Appraisal: 1. Hierarchy (or levels) of evidence 2. Hierarchies consist of varying levels of research ranked by: a. Subject area or discipline b. Type of research done within a discipline c. Committees or organizations who create EB guidelines. 3. EBP does not assume the innate superiority of any particular research design.
  15. 15. For the convenience of readers, scholarly articles in many disciplines evolved to follow an IMRAD format (or something like it). Critical Appraisal: IMRAD I Introduction: Background, rationale, and purpose of study. M Methods: Study design, measurement instruments, and rationale for their use. R Results: Describes the results without repeating methodology A Analysis (some articles include this): statistical analysis. D Discussion: principles, relationships, and generalizations drawn from study; how results support or refute previous work; theoretical implications; conclusions.
  16. 16. • Experimental or Observational • Quantitative or Qualitative • Take a look at the research methods of a given field to determine their study designs, and how (or if) evidence-based practice can be utilized. • An appropriate study design will be determined by the nature of the question being answered. Types of Study Designs
  17. 17. Part of critical appraisal is to identify potential sources of bias in order to evaluate the validity of a study. Common Types of Bias (Among Many): • Conflict of Interest Bias • Wrong Sample Size Bias • Positive Results Bias • Correlation Bias • Missing Clinical Data Bias • Publication Date Bias Identifying Bias
  18. 18. Pyramid of Evidence, Medicine Meta- Analysis Systematic Review Randomized Control Trial Cohort Studies Case Control Studies Case Series Case Reports Editorials, Opinions, and Ideas Animal Research In Vitro Research Examples of Hierarchies
  19. 19. Hierarchy of Evidence for Intervention/ Treatment Questions in Nursing, Melnyk Model (Melnyk & Fineout- Overholt, 2018) Examples of Hierarchies
  20. 20. Hierarchy of Research Methods, Social Work Examples of Hierarchies Meta- Analysis Systematic Review Randomized Control Trial Quasi- Experimental Studies Case Control Studies Cohort Studies Pre-Experimental Group Studies Surveys Qualitative Studies
  21. 21. • Cookbook approach: simplifies practice and stifles creativity. • Time between doing research and getting published: empirical research is time consuming and can take up to 2 years before it is published. • Lack of evidence: Cannot address concepts that are not widely studied or published. • Overlooks the human experience: its outcome- based focus may simplify the complexity of people (Baumann, 2010). Shortcomings or Arguments Against EBP
  22. 22. • Indexes & Databases (Discipline-Specific) • Well-Designed Empirical Articles • Systematic Reviews • Meta-Analyses • Journals • Evidence-Based Focus • Gray Literature • Professional Associations • Government Agencies • Use based on professor/assignment preferences. Sources of Evidence
  23. 23. Cochrane: The Cochrane Library: www.cochrane.org/ The Cochrane Library is comprised of 6 different databases that provide information supporting the top three levels of the hierarchy of evidence:  Systematic Reviews/Meta Analysis: CDSR: Cochrane Database of Systematic Reviews  Randomized Controlled Trials CENTRAL: The Cochrane Central Register of Controlled Trials  Cochrane Clinical Answers (CCAs) Sources of Evidence: Health Sciences
  24. 24. Use limiters and other features available to filter results. CINAHL • Limiters • Clinical Queries: therapy, prognosis, review, qualitative, etiology • Randomized Controlled Trials PubMed • Clinical Queries: therapy, diagnosis, etiology, prognosis, systematic reviews, and clinical prediction guides Sources of Evidence: Health Sciences
  25. 25. The Campbell Collaboration Online Library: www.campbellcollaboration.org/library.html • Systematic reviews in the fields of education, criminal justice and social welfare are freely available online. • Includes plain language summaries. Social Work Policy Institute: www.socialworkpolicy.org/research/evidence-based-practice-2.html SAMSHA Guide to Evidence-Based Practices: www.samhsa.gov/ebp-web-guide • EBP for substance abuse and treatment, mental health disorders prevention and treatments, and adult EBPs. Journal of Evidence-Based Social Work Sources of Evidence: Social Work
  26. 26. National Institute of Corrections • Evidence-Based Decision Making: info.nicic.gov/ebdm/ • Evidence-Based Practices: nicic.gov/evidence-based-practices-ebp Crime Solutions.Gov: www.crimesolutions.gov/default.aspx National Criminal Justice Reference Service: www.ncjrs.gov Criminal Justice Policy Review Sources of Evidence: Criminal Justice
  27. 27. • Best Evidence Encyclopedia (John Hopkins University): www.bestevidence.org/ • What Works Clearinghouse (Institute of Education Sciences): ies.ed.gov/ncee/wwc/ • Evidence-Based Practices in Instruction (U.S. Dept. of Education): ccrs.osepideasthatwork.org/teachers- academic/evidence-based-practices-instruction • Culturally Responsive Teaching (Education Northwest): educationnorthwest.org/resources/culturally- responsive-teaching-guide-evidence-based-practices- teaching-all-students • Journal of Evidence-Based Practices for Schools Sources of Evidence: Education
  28. 28. FAU Libraries Evidence-Based Practice LibGuide: libguides.fau.edu/evidence-based-practice-boca Buskist, W., & Grocca, J.E. (Eds.) (2011). Evidence-based teaching. San Francisco, CA: Jossey-Bass. Holland, K., & Rees, C. (2010). Nursing: Evidence-based practice skills. New York: Oxford University Press. Patterson, G.T., & Graham, W.K. (2018). Clinical interventions in criminal justice settings: Evidence-based practice. Cambridge, MA: Academic Press. Roberts, A.R., & Yeager, K.R. (2006). Foundations of evidence-based social work. New York: Oxford University Press. Straus, S.E., Richardson, W.S., Glaszious, P., & Haynes, R.B. (2010). Evidence-based medicine: How to practice and teach it (4th Ed.). New York: Churchill Livingstone. More Information
  29. 29. References Baumann, S.L. (2010). The limitations of evidence-based practice. Nursing Science Quarterly, 23(3): 226-230. doi:10.1177/0894318410371833 Melnyk, B., & Finout-Overholt, E. (2018). Evidence-based practice in nursing and healthcare: A guide to best practice (4th Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins. National Council of Social Workers (2018). Evidence-based practice: NASW practice snapshot. Retrieved from https://www.socialworkers.org/News/Research-Data/Social- Work-Policy-Research/Evidence-Based-Practice Sackett, D.L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W.S. (1996). Evidence based medicine: What it is and what it isn't. BMJ, 312(7023): 71-72.

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