Evidence-based practice (EBP) in health care is an old concept with a new name, with the principles embedded in everyday life. EBP is the integration of current, best research results, clinical expertise, and the unique circumstances and values of the patient.1 These components are used in everyday life. Consider helping a friend buy a new computer. First, you would research the various brands and models that are on the market; some are better than others. For a few more dollars, you may be able to purchase a computer with more features, but are they worth it? During this process, you would call on the second element, your personal experience and expertise. What brands have worked well in the past? Finally, you must consider the circumstances and values of your friend. Is cost or portability more significant? Failure to recognize these personal needs and values could lead to inaccurate results (unless you guessed correctly). If your friend simply must have a portable computer, no amount of research will make a desktop computer a good choice.
Evidence-based practice, a foundation of best practice, is the incorporation of three elements into the decision-making process of patient care: (1) best available research, (2) clinical expertise, and (3) the circumstances and values of the individual patient. These concepts are intertwined with the patient examination, the clinical diagnosis, and subsequent intervention plan.2
EBP came into focus as the result of rising medical costs, including surgery and other interventions that are paid for by insurance companies. As a result of the costs associated with these techniques, insurance companies began to question their efficacy. Research indicated that some techniques did not provide significant improvement in patient outcomes. Other procedures required prolonged follow-up care or repeat surgeries, provided no additional benefit to the patient, or were less efficient and more expensive than other techniques.3 To receive payment, insurance companies began to require that the procedures being billed actually helped patients improve in a timely, efficient manner. Thus began the modern movement toward evidence-based practice.
Applying EBP to patient care assists in making informed decisions about the most effective approaches to maximize the outcome for the client/patient. Each disease or injury is associated with multiple prevention strategies, diagnostic approaches, and intervention strategies. EBP provides a framework to determine if one strategy is better than another, if both strategies are similar, or if one is just simply wrong.
EBP is a process rather than a technique.4 Information—evidence—is gathered from unbiased sources such as peer-reviewed journals that address the clinical problem. Some types (levels) of information are more compelling than others (Box 3-1). For example, a meta-analysis collectively examines a body of research on a specific topic. Combined with randomized clinical trials, these types of research provide the strongest arguments for the inclusion or exclusion of a particular technique ...