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Description
& Purpose of Evidence-Based Medicine
EBM
is the "integration of best research evidence with
clinical expertise and patient values."
(Centre for Evidence-Based Medicine - Canada, 2000). The scientific method
is used to determine the best treatment for a problem, given the available research
evidence. EBM is often an multidisciplinary process. If you are
not involved in
the process, you should have a basic understanding of its product--a recommendation
of practice that is best for patients, based on solid research.
The
purpose of EBM is to decide on clinical guidelines for the best (and, usually, most
cost effective) treatment for a clinical problem. Third-party payers
want to reimburse
providers who offer the best quality for the least cost, a goal that is
met by
practicing "evidence-based medicine" and by following standardized
clinical guidelines.
Hospitals and other health care organizations use clinical
guidelines for a
similar purpose, to insure quality care while keeping costs
down.
Evidence-based
nursing (and evidence-based mental health, and so on) follow the
same purposes and methods as EBM. As more and more nursing research demonstrates
the usefulness of certain nursing interventions, evidence-based nursing
(EBN) helps us demonstrate that nursing interventions make a difference
in quality of care and costs.
Health
policy changes are logical consequences of EBM and EBN, based on scientific
evidence rather than on politics or the whims and gut feelings of health
policy planners.
EBM
Methodology
EBM
is a five-step process (Badenoch & Heneghan, 2002, p. 1):
1.
Asking a clinical question. What patient problem are you addressing?
2.
Searching the literature on the question. What research has been done
on this problem?
3.
Reviewing the literature for its validity and relevance to the question.
What is the quality of the studies that have been done on this
problem?
4.
Making a decision about the best intervention for the question. What
are the best interventions for this problem, based on the research?
5.
Evaluating the decision you made. How well do these interventions
work for our patients?
Notice
how EBM corresponds to the nursing process:
| EBM |
Nursing Process |
| Asking
a clinical question. |
Assessing
the patient |
| Searching
the literature on the question. |
Examining
different options for intervention |
|
Reviewing
the literature for its validity and relevance to the question.
|
Deciding
on an intervention |
|
Making
a decision about the best intervention for the question.
|
Intervening |
| Evaluating
the decision you made. |
Evaluating
the patient after administering the intervention |
Reviewing
the literature on the question
The
most important part of reviewing the literature is reviewing valid
literature, i.e.,
literature that truly addresses the clinical problem and population you have chosen.
The most valid studies are those that
investigate your clinical problem in your
type of patients, eliminating the possibility that other factors besides
the intervention
affect outcome. Thus, the studies you examine should include randomization
to treatment and control groups and blind participation by subjects (i.e.,
subjects are unaware of what the intervention is). Treatment and control groups
should be comparable at both the beginning and the ending of the research,
and outcomes studied should be similar across studies.
Lest
you fear the "academic" nature of the EBM process, note that it is
done by professionals,
in groups, whether a large government effort to find the most useful treatment
at the lowest cost or a hospital committee effort to develop care paths or
care maps based on the best and latest research. Nurses are among
those professionals.
The
group's charge is to critically examine available research in order to
come up with
a decision about the best intervention. Someone in the group needs
to be knowledgeable
about the statistics relevant to EBM, and this person could be a nurse
with statistical knowledge. Practicing nurses are qualified to judge
the clinical
aspects of the literature.
Many
parallel efforts have evolved from EBM, such as evidence-based pathology, evidence-based
pharmacology, and evidence-based nursing (EBN). EBN will be the
subject of Clinical Nursing Resources, Volume 1, Number 13.
Bibliography
Badenoch,
D., & Heneghan, C. (2002). Evidence-based Medicine Toolkit.
London:
BMJ
Books.
Centre
for Evidence-Based Medicine - Canada. (2000). What is EBM?
Retrieved July 7,
2002. http://www.cebm.utoronto.ca/intro/whatis.htm.
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