EBM begins and ends with the patient. The clinician sees a patient and an issue arises that represents a knowledge gap or question for the practitioner. A clinical question drives the rest of the process to acquire evidence that addresses the issue and provides recommendations for decision making.
Not all evidence is created equal. There are various frameworks for evidence rigor, but generally the strongest evidence is derived from multiple, well conducted randomized clinical trials. The level of evidence is dictated by both the type of study and the quality of the study or studies. Evidence from a single large, well-conducted RCT is considered better evidence than evidence from a rigorous case-control or cohort study. Expert opinion is considered to be the lowest level of evidence.Systematic reviews and meta-analyses provide recommendations from a cohort of studies that meet specific criteria.
Study populations should represent the same demographic as the patient, with similar health status.
ASK - Develop and answerable clinical question; use the PICO format to help create the question:
P - Patient
I - Intervention
C - Comparison
O - Outcome
ACQUIRE - Use the PICO elements to inform a search stategy;
APPRAISE - What evidence was found? Are the results valid? What is the strength of the evidence? Are results applicable to this patient in this situation?
APPLY - Apply the evidence and share what you found with the patient.
The primers were developed by the Lamar Soutter LIbrary at the UMASS Medical School and provide quick reviews of EBM processes and appraisal.