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Evidence-Based Medicine
by Becky Sisk, PhD, RN © 2006 |
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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:
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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