Evidence-based practice (EBP) is the integration of current, best research results, clinical expertise, and the unique circumstances and values of the patient.1 These components are commonly 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. For example, if your friend simply must have a portable computer, no amount of research will make a desktop computer a good choice.
When using evidence to support best healthcare practice, adopting this approach provides a systematic method for structuring the clinical diagnostic approach and determining management strategies. This chapter details the components of EBP only as they relate to clinical diagnostic techniques and describes how these components are incorporated into the remainder of this text. Many excellent resources describe the process of researching and interpreting the literature and present a broader picture of evidence-based practice.
Adopting an evidence-based approach to patient care requires a commitment to asking well-formed clinical questions and seeking answers from contemporary resources. As is the nature of research, much of the EBP information presented in this text will change with time. The reader is advised to supplement the information provided in this text with that found in current peer-reviewed journals.
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 exam ination, the clinical diagnosis, and subsequent intervention plan.2
EMERGENCE OF EBP AND LEVELS OF EVIDENCE
Rising medical costs, including surgery and other interventions paid for by insurance companies, led to an emphasis on EBP leading to insurance companies to questioning the efficacy of these techniques. Research indicated that some techniques did not significantly improve 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 helps clinicians make informed decisions about the most effective approaches to maximize patient outcomes. Diseases and ...