Evidence-Based Practice (EBP) is the framework for your clinical decision-making process. It is the integration of
Therapy - What is the treatment for a disease?
Diagnosis - power of a test to differentiate between those with and without a disease?
Prognosis - a patient’s likely course over time due to factors other than interventions?
Etiology/Harm - effects of potentially harmful agents on the patient?
- Review the Situation (Assess)
- Define the clinical problem as a question (Ask)
- Select resources, design a strategy, and search for the
- Summarize the evidence yield (Appraise)
- Apply the evidence (Apply)
The level of evidence can be defined by the type of question. Levels of evidence for a "Therapy" question are different from the levels of evidence for an "Etiology" question. Please review the following from The Centre for Evidence-Based Medicine at Oxford:
|I||Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.|
|II||Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT).|
Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).
|IV||Evidence from well-designed case-control or cohort studies.|
|V||Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).|
|VI||Evidence from a single descriptive or qualitative study.|
Evidence from the opinion of authorities and/or reports of expert committees.
The table above is based on the following: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based nursing care guidelines: Medical-surgical interventions. (p. 7). St. Louis, MO: Mosby Elsevier.
|Type of Question||Suggested Best Type of Study|
|Therapy||RCT > prospective cohort|
|Diagnosis||Prospective, blind comparison to a gold standard|
|Etiology/Harm||RCT > cohort > case control > case series|
|Prognosis||cohort study > case control > case series|
|Prevention||RCT > cohort study > case control > case series|
|Clinical Exam||prospective, blind comparison to gold standard|