Comprehensive Guide to Evidence-Based Practice Models and Implementation

1. Evidence-Based Practice

2. Evidence-Based Practice The Star Model

3. Evidence-Based Practice • Discovery – multitude of articles • Summary – systematic reviews • Translation – clinical recommendations • Integration – change in practice • Evaluation – change in health outcomes

4. Clinical Effectiveness of EBP • Feasibility – is it practical • Appropriateness – does it fit situation • Meaningfulness – opinions, values, beliefs • Effectiveness – best available evidence, not necessarily the best possible

5. Barriers to Translating Evidence into Practice • Financial disincentives • Lack of skills, facilities or equipment • “Standard of Care” based on consensus • Lack of knowledge – persons or experts • Belief that “Guidelines” are cookbooks • Misinformed lay public

6. Rating System for Grading Levels of Evidence • Level I • Multiple randomized controlled trials • Randomized trials with large sample sizes and large effect sizes • Level II • Evidence from at least one well-designed RCT • Single randomized trials with small samples

7. Rating System for Grading Levels of Evidence • Level III • IIIA • Evidence from well-designed trials without randomization • IIIB • Evidence from studies of intact groups • Ex-post facto and causal comparative studies • Case/control or cohort studies

8. Rating System for Grading Levels of Evidence • IIIC • Evidence obtained from time series with and without an intervention • Single experimental or quasi-experimental studies with dramatic effect sizes • Level IV • Evidence from integrative reviews • Systematic reviews of qualitative or descriptive studies • Case series, uncontrolled studies, expert opinion

9. Johns Hopkins Model of EBP Implementation • Practice Question • Identify an EBP question • Define scope of practice question • Assign responsibility for leadership • Recruit a multidisciplinary team • Schedule a team conference

10. Johns Hopkins Model of EBP Implementation • Evidence • Conduct internal and external search for evidence • Critique types of evidence • Summarize evidence • Rate strength of evidence • Develop recommendations for change in processes of care or systems based on strength of evidence

11. Johns Hopkins Model of EBP Implementation • Translation • Determine appropriateness and feasibility of translating recommendation into the specific practice setting • Create an action plan • Implement the change • Evaluate the outcomes • Report the results of the preliminary outcomes to decision makers • Secure the support from the decision makers to implement recommended change internally • Identify the next steps • Communicate the findings