EvidenceBased Practice EvidenceBased Practice The Star Model EvidenceBased

Evidence-Based Practice

Evidence-Based Practice The Star Model

Evidence-Based Practice • • • Discovery – multitude of articles Summary – systematic reviews Translation – clinical recommendations Integration – change in practice Evaluation – change in health outcomes

Clinical Effectiveness of EBP • • Feasibility – is it practical Appropriateness – does it fit situation Meaningfulness – opinions, values, beliefs Effectiveness – best available evidence, not necessarily the best possible

Barriers to Translating Evidence into Practice • • • Financial disincentives Lack of skills, facilities or equipment “Standard of Care” based on consensus Lack of knowledge – persons or experts Belief that “Guidelines” are cookbooks Misinformed lay public

Rating System for Grading Levels of Evidence • Level I – Multiple randomized controlled trials – Randomized trials with large sample sizes and large effect sizes • Level II – Evidence from at least one well-designed RCT – Single randomized trials with small samples

Rating System for Grading Levels of Evidence • Level III – IIIA • Evidence from well-designed trials without randomization – IIIB • Evidence from studies of intact groups • Ex-post facto and causal comparative studies • Case/control or cohort studies

Rating System for Grading Levels of Evidence – IIIC • Evidence obtained from time series with and without an intervention • Single experimental or quasi-experimental studies with dramatic effect sizes • Level IV – Evidence from integrative reviews – Systematic reviews of qualitative or descriptive studies – Case series, uncontrolled studies, expert opinion

Johns Hopkins Model of EBP Implementation • Practice Question – – – Identify an EBP question Define scope of practice question Assign responsibility for leadership Recruit a multidisciplinary team Schedule a team conference

Johns Hopkins Model of EBP Implementation • Evidence – – – Conduct internal and external search for evidence Critique types of evidence Summarize evidence Rate strength of evidence Develop recommendations for change in processes of care or systems based on strength of evidence

Johns Hopkins Model of EBP Implementation • Translation – Determine appropriateness and feasibility of translating recommendation into the specific practice setting – Create an action plan – Implement the change – Evaluate the outcomes – Report the results of the preliminary outcomes to decision makers – Secure the support from the decision makers to implement recommended change internally – Identify the next steps – Communicate the findings