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Welcome to Evidence Based Practice: Improving Practice, Improving Outcomes.
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My name's Anne Dabrow Woods and I'm the Chief Nurse of Wolters Kluwer Health Medical Research Division, which consists of Lippincott Williams & Wilkins and Ovid Technologies.
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And today I'm here to talk to you about evidence-based practice, what it is, what it isn't, why it makes a difference, and why it is so crucial to what's going on in healthcare today.
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So what is the top global challenge that faces everyone, no matter where you are, if you're in the United States, if you're in Australia, if you're in Europe?
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Everyone faces the same challenge in healthcare today, and that is to provide the evidence-based, cost-effective, quality care that will improve practice and improve patient outcomes.
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That is the number one challenge faced by all healthcare providers and healthcare institutions today.
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Why is this such an issue?
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Only 20% of what we do as healthcare providers is based on evidence.
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That means 80% of what we do is not based on evidence.
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And only 55% of the time patients get the evidence-based recommendations to base their treatment.
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That means the remainder of the time they are not getting the latest standard of care.
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The other thing that's really important to consider here is it takes 15 to 20 years to get evidence into practice.
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And that's simply way too long.
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What this all means is our patients are not getting the care that they deserve.
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So what is the solution?
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The solution is to integrate evidence into practice to improve patient outcomes.
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And the true overall solution is the Joanna Briggs Institute.
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So let's talk about a little bit about the beginning of evidence-based practice.
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Well, evidence-based practice really started back in the 1970s with Archie Cochrane, who was an epidemiologist out of the United Kingdom.
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And he took a look at the way healthcare was being delivered in that country.
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And what he realized is that patients were dying.
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They were not getting the quality of care that they needed.
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So he decided to look at a study where he took two groups, one
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Evidence-based practice and evidence-based decision making is based on:
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External evidence - systematic reviews, randomized control trials, best practice, and clinical practice guidelines that support a change in clinical practice.
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Internal evidence - healthcare provider expertise, quality improvement projects, outcome management initiatives.
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Patient.
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Preferences - what does the patient really want when given several different options?
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Patient values - quality of life.
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The myth of evidence-based practice.
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EBP resources do not make an EBP institution.
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So why use evidence-based practice?
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It leads to the highest quality care and patient outcomes.
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It reduces healthcare costs.
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It increases reimbursement and decreases denials.
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It reduces geographic variations in the delivery of care.
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It increases clinician empowerment and role satisfaction.
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It reduces healthcare provider turnover rate.
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It meets the expectations of an informed public.
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Types of research: Quantitative.
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Intervention and outcome research based on scientific methods.
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Uses experimental controls and manipulation of variables.
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Uses instruments to test and measure data.
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Uses statistics to interpret data.
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Examples.
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Clinical trial - study is assigned by researcher.
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Randomized controlled trial - assignment to an exposure is randomized.
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Cohort study - observational study where people are followed forward in time to determine outcomes.
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Case-control study - observational study with a control group that looks back in time (chart reviews).
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Case report or case series - descriptive study without a comparison group.
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Meta-analysis - analyzes several studies around the same or related hypothesis; often part of systematic reviews.
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Clinical practice guidelines - identify and summarize the evidence related to prevention, diagnosis, prognosis, and treatment.
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Types of research: Qualitative.
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Used to understand human behavior.
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Uses observations to assess group culture, beliefs, actions, and adaptation to life situations.
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Data collection - direct observations, focus groups, key opinion leader interviews, contextual design.
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Directional research - often done in with quantitative research or before it.
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Examples.
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Phenomenology - philosophy.
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Focus on individual meaning, the "phenomenon".
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Ethnography - anthropology.
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Focuses on culture, social meaning.
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Grounded Theory - social sciences.
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Generates explanations, develops a theory.
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Action Research - social sciences.
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Researcher interacts with the participants to achieve change & empowers community to take back control and make change.
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out of anthropology, so we look at groups of people who have a certain condition.
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We know that qualitative research is very, very important to how we deliver care today, because you need to make sure that your patients are having a good experience with the care they're receiving.
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Now, the highest level of research is considered secondary research, and this is the thing that we call a systematic review or meta-analysis.
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And what is different about a systematic review and a meta-analysis is that it brings the same level of rigor to the review of all the research studies that have been done on a specific topic.
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It brings the same level of rigor to the analysis of all those studies.
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Here's another caveat.
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Systematic reviews are very different than literature reviews.
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Because systematic reviews and meta-analyses actually have to be peer-reviewed.
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So that means two or more people have to be appraising all the studies that are included in a systematic review or a meta-analysis.
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When you do a systematic review, you also need to look at a few other things.
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To make sure that it's important to how we provide care to our patients.
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You need to look at, is it really feasible, the results of the systematic review?
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Can I really implement this with a specific patient population?
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Is it going to be appropriate?
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Is it meaningful to patient populations and to my practice as a healthcare provider?
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And is it going to be effective?
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Is it really going to make a difference?
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We do know, though, that research evidence is not created equal.
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So it's really important when healthcare providers take a look at the research that they get from a search, they need to determine what level of research they're looking at.
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At the base, we have all the original research studies, and these are the things like the randomized control studies.
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And and those type of things.
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The next level up would be the systematic reviews and the meta-analyses.
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Again, the systematic review and meta-analysis is done by a researcher looking at all the original research around a certain topic.
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Doing a critical appraisal of it, a synthesis of it, and then putting it together as a systematic review.
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So that's considered the higher level of of research, um, in the hierarchy of evidence.
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But at the very top is our clinical decision support.
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And clinical decision support are tools that healthcare providers can use, they read immediately, and they go put into practice immediately.
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Now, why is this important?
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Because healthcare providers at the bedside do not have time to read 100, 200, 300 page systematic reviews or meta-analysis and then go make a decision about a patient.
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They have to read the evidence and put it into practice immediately.
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And that's what clinical decision support tools do.
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All clinical decision support tools should be based on systematic reviews, meta-analyses, evidence summaries, or the best available evidence.
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The Joanna Briggs Institute goes one step further.
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So they look at the levels of evidence, as we stated before, with the systematic reviews certainly being at the highest level.
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But they also look at the other things I had mentioned before.
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They look at the feasibility, the appropriateness, the meaningfulness, and the effectiveness of each recommendation to see if it will really make a difference in what we do in healthcare practice today.
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But they add one more piece to that.
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They look at the economic evidence.
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Because let's face it, if an intervention is going to cost a healthcare system hundreds of thousands of dollars.
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It is not going to be worthwhile for that system to put it in place because it's going to bankrupt the system.
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So we need to make sure that the interventions that we are applying to our patients make good economic sense and they're also effective for our patients.
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So what is evidence-based practice methodology?
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What is it?
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Well, there's many methodologies around evidence-based practice.
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But when you look at all of them, they have some of the same attributes.
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And the first one is they look at finding the evidence, generating the evidence, being able to search it.
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And this is all done after you develop a good research question.
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A burning question that a clinician needs to answer to change care for a patient.
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The second piece is they need to appraise the evidence.
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To see if it's good enough to put into practice.
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Then they need to implement the evidence to have it make a difference.
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And here's the key point.
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They then have to go back and evaluate the practice changes to see if what they've done have really made a difference.
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This is true evidence-based practice.
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And unless a healthcare organization is doing all of these pieces, then they're really not truly an evidence-based practice institution.
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The JBI methodology fits each of these pieces.
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The first piece is healthcare evidence generation.
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And this is where they actually take a look at all the research that is out there.
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Their second piece is evidence synthesis.
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And this is the same thing basically as evidence appraisal.
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Their third piece is evidence knowledge transfer.
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And that would be the evidence implementation piece.
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They have evidence utilization where actually evidence is in use.
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And then during the evidence utilization piece, they actually go back and they evaluate whether or not the practice changes that have been put into place have really made a difference for our patients and our practice.
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Now, JBI is a group out of South Australia, in Adelaide, Australia.
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But make no mistake, they are
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Healthcare providers need the latest evidence.
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To appraise it.
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They need to implement it.
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They need to evaluate whether or not what they've done has made a difference.
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Researchers need to do all four parts of evidence-based practice.
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They're the ones who are generating the evidence, appraising it, implementing it, and then evaluating whether or not the practice changes that the healthcare providers have made have made a difference.
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Faculty, it's very, very important.
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Today in academia, the concepts of evidence-based practice have to be integrated throughout all our educational systems as part of the curriculum.
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So faculty need to teach the concepts of evidence-based practice.
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And certainly everything that they're teaching about diseases, conditions, latest diagnostic studies, treatment recommendations has to be integrated throughout their curriculum.
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And using a program like Joanna Briggs Institute will help them to be able to do that.
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Students are very, very important.
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We need to make sure we're teaching our students the latest evidence.
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So they can go out and provide the very best care.
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They're going to use it to learn about diseases and conditions.
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The latest diagnostics.
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Treatment recommendations.
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They also need to know how to appraise the evidence.
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Because when you look at the number of studies that are released every year related to healthcare interventions.
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A student needs to know which ones they should use to change their practice.
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So I hope you understand that evidence-based practice is not just about providing the evidence and then calling yourself an evidence-based practice institution.
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It's really about taking the evidence, appraising it, implementing it into practice, and then evaluating whether or not what you've done has made a difference.
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That is true evidence-based practice.
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Thank you very much.
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