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 Levels of Evidence is a hierarchy of the likely best evidence. The level of evidence can be defined by the type of question. Please review the Levels of Evidence Introductory Document and other information from The Centre for Evidence-Based Medicine at Oxford:
|Ib||Randomized controlled trials (RCTs)|
|II||Controlled study without randomization|
|IV||Case series or expert opinion, clinical experience of respected authorities|
|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|
Questions of therapy and prevention which can best be answered by a RCT can also be answered by a systematic review or meta-analysis.