Healthcare provided should be evidence based and the reasons for this.....

1. EVIDENCE BASED HEALTHCARE
Aarti Sareen
M.S.P.T.(Honours)

2. Evidence-based history
• Evidence-based philosophies integrate a health
professional’s experience and knowledge with the
best currently available clinical evidence.
• It was introduced as EBM by ACP Journal Club in
1991 and this editorial was the impetus for a a series
called the Users’ Guides to the Medical Literature in
order to help clinician decide how to incorporate
these philosophies in to their daily practice.

3. Evidence-based evolution
Evidence-based medicine
Evidence-based health care, practice,
dentistry, nursing etc.
Evidence-based medical / health
librarianship
Evidence-based librarianship

4. Evidence based health care
• is the conscientious use of current best evidence in making
decisions about the care of individual patients or the delivery
of health services. Current best evidence is up-to-date
information from relevant, valid research about the effects of
different forms of health care, the potential for harm from
exposure to particular agents, the accuracy of diagnostic tests,
and the predictive power of prognostic factors
• Cochrane AL. Effectiveness and Efficiency : Random Reflections on Health Services. London: Nuffield Provincial Hospitals
Trust, 1972. Reprinted in 1989 in association with the BMJ. Reprinted in 1999 for Nuffield Trust by the Royal Society of
Medicine Press, London, ISBN 1-85315-394-X.

5. Health care professionals
• a person who by education, training,
certification, or licensure is qualified to and is
engaged in providing health care.

6. Why to go for evidence based
health care

7. Knowing is not enough; we
must apply
Willing is not enough; we
must do…..
Goethe

8. Clinical Decisions
• Achieving a diagnosis
• Estimating a prognosis
• Choosing to intervene
• Choosing an
intervention
• Determining Harm

9. What kinds of clinical uncertainty
do HCP face?
• Interventions
– Therapy
– Prevention
– Targeting
– Timing
• Diagnosis
• Communicating risks and
benefits
• Referral
• Service Delivery/Organisation
One choice every 10 minutes in
acute care

10. • Evidence based practice is followed to
give/provide evidence based healthcare.

11. Evidence-based approach
1. Formation of a clinical question (s) (usually from an existing
clinical scenario). It is formed using the following formula of
PICO(T):
• Patient/population
• Intervention
• Comparison
• Outcome
• Time

12. Population
Who are the relevant people?

13. Intervention
What are they exposed
to?

14. Alternative or control
intervention

15. Outcome (what are the person-
level consequences we are
interested in?)

16. Evidence-based approach
2. A literature search to identify the evidence
– Biomedical database searches, textbook searches,
grey literature, hand searching etc.
3. Critical Appraisal of the literature search
results
4. Application of the results to the patient
5. Quality assurance of the previous steps

17. The total body of
research is distilled
down to a conclusion
based on the best
available, reliable and
Poor quality
relevant research
and/or
irrelevant
research

18. Example
In a 61 year-old women with osteoporosis (P),
does the regular aerobic exercise versus
exercise 4 times a week improve bone density
and reduce the risk of fractures ?

19. Only approximately 10% of articles
in the most prestigious internal
medicine journals can be regarded
as “valid” and ready for application

20. Redesign the healthcare services

21. 10 rules for redesigning health care
1. Care based on continuous healing relationships--care
whenever its needed, not just through face to face visits
2. Customization based on patient needs and values
3. The patient as the source of control
4. Shared knowledge and free flow of information
5.Evidence based decision making
6. Safety as a system property
7. The need for transparency--all information available, including
the system’s performance on safety, evidence based practice,
and patient satisfaction
8. Anticipation of needs

22. 10 rules for redesigning health care
• 9. Continuous decrease in waste
• 10. Cooperation among clinicians

23. Six challenges for health care
organizations
• 1. Design seamless, coordinated care
• 2. Make effective use of IT, including automating
patient records
• 3. Manage knowledge so that it is delivered into
patient care
• 4. Coordinate care across patient conditions,
services, and settings over time
• 5. Advance the effectiveness of teams
• 6. Incorporate measurement of care processes and
outcomes into daily practice

24. Getting evidence into health care delivery
1. Ongoing analysis and synthesis of medical evidence
2. Delineation of guidelines
3. Identification of best practices in design of care processes
4. Better dissemination to professionals and public
5. Decision support tools
6. Goals for improvement
7. Measures of quality for priority conditions