Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences

2009 ◽  
Vol 24 (4) ◽  
pp. 298-305 ◽  
Author(s):  
David A. Bradt
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Strategic Decision ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Strength Of Evidence ◽  
Based Medicine ◽  
Evidence Based Decision Making

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.

scholarly journals L'assistenza sanitaria basata sul valore

2020 ◽  
Vol 28 (4) ◽  
pp. 227-228
Author(s):  
Giovanni Battista Zito
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Cost Reduction ◽  
Evidence Based ◽  
Related Concept ◽  
New Approach ◽  
The Individual ◽  
Based Medicine ◽  
Evidence Based Decision Making

In the last decades, paternalistic medicine based on the principles of “science and conscience”, has been definitively replaced by evidence-based medicine, in order to ensure that only interventions with strong evidence of clinical efficacy/utility will be used. Evidence-based medicine, however, has two main limitations. The first one is that it fits with difficulty to the individual pa-tient. To overcome this limitation, precision medicine has been founded. The second and main limitation is that evidence-based medicine and the related concept of clinical appropriateness do not consider the costs of health services. Clinical appropriate-ness should therefore be closely associated with organizing appropriateness, to give absolute relevance to both the concepts of risk/effectiveness and cost/effectiveness of the healthcare. Accordingly, every intervention aimed at improving individual and public health should include evidence-based decision making, quality improvement and cost reduction. These features are all nec-essary but not sufficient. A new approach is emerging, called value-based healthcare, which aims to privilege activities capable of generating value, in a new model of healtcare in which interventions are reimbursed on the base of the results obtained on the whole community health.

scholarly journals Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisanne S. Welink ◽  
Kaatje Van Roy ◽  
Roger A. M. J. Damoiseaux ◽  
Hilde A. Suijker ◽  
Peter Pype ◽  
...  
Keyword(s):  
Decision Making ◽  
General Practice ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Stimulated Recall ◽  
Previous Discussion ◽  
Based Medicine ◽  
Stimulated Recall Interviews ◽  
Gp Training

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.

Evidence-Based Practice and Public Health

2018 ◽  
Author(s):  
Patrick Bryant ◽  
Peter D Hurd ◽  
Ardis Hanson
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Public Health Practice ◽  
Standards Of Care ◽  
Evidence Based ◽  
Clinical Knowledge ◽  
Health Practice ◽  
Challenges And Opportunities ◽  
Based Medicine ◽  
Evidence Based Decision Making

The most difficult step of evidence-based medicine (EBM) and evidence-based public health (EBPH) is to link the evidence with current clinical knowledge and experience, especially with the continued focus on using evidence in decision-making. Standards of care and clinical practice guidelines are now established and reported using nationally and globally recognized protocols to ensure standard nomenclature and clinical crosswalks. This chapter examines relevant background issues, including concepts underlying EBM, EBPH, and definitions of evidence; describes key analytic tools to enhance the adoption of evidence-based decision-making; and finishes with challenges and opportunities for implementation in public health practice.

The Other War on Drugs: The Pharmaceutical Industry, Evidence-Based Medicine, and Clinical Practice

2007 ◽  
Vol 19 (1) ◽  
pp. 49-70 ◽  
Author(s):  
Howard I. Kushner
Keyword(s):  
Evidence Based Medicine ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Epidemiology ◽  
Meta Analysis ◽  
General Medicine ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Based Medicine

Over the past decade, evidence-based medicine (EBM) has become the standard for medical practice.1 Evidence-based practices have been established in general medicine and specialized fields; new evidence-based journals have been launched.2 Although its roots can be found in mid-nineteenth-century medical philosophy, contemporary EBM was largely developed by the clinical epidemiology program at McMaster University in 1992.3 According to the McMaster manifesto published in JAMA, EBM “deemphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making, and stresses the examination of evidence from clinical research.”4 The most frequently cited definition of EBM is reliance on the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,” based on an integration of “individual clinical expertise with the best available external clinical evidence from systematic research.”5 However, as Stefan Timmermans and Aaron Mauck recently observed, EBM “is loosely used and can refer to anything from conducting a statistical meta-analysis of accumulated research to promoting randomized clinical trials, to supporting uniform reporting styles for research, to a personal orientation toward critical self-evaluation.”6

scholarly journals Dari Penelitian Ke Praktek Kedokteran

Sari Pediatri ◽  
2016 ◽  
Vol 3 (1) ◽  
pp. 42
Author(s):  
Dody Firmanda
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Governance ◽  
Evidence Based ◽  
Organizational Cultures ◽  
Clinical Leadership ◽  
Based Medicine ◽  
Evidence Based Health Care ◽  
Evidence Based Decision Making

Salah satu komponen latar belakang dari tujuan dilakukannya suatu penelitian adalah relevansi penelitian tersebut terhadap kemajuan ilmu pengetahuan, membuat kebijakan (policy) klinis dalam penatalaksanaan pasien secara individu ataupun kelompok serta kebijakan kesehatan secara lebih luas dalam suatu sistem tingkat institusi penyelenggara kesehatan baik tingkat rumah sakit (standard of procedures) maupun nasional (guidelines). Pada abad 21 ini dengan semakin meningkatnya tekanan dan tuntutan, pesatnya perkembangan teknologi kedokteran/kesehatan dan semakin terbatasnya sumber dana serta perubahan globalisasi, diharapkan pengambilan keputusan yang tepat dan baik akan bergeser ke arah ‘Evidence-based decision making’. “Evidence-based Medicine (EBM)” dan “Evidence-based Health Care (EBHC)” adalah cara pendekatan untuk mengambil keputusan dalam penatalaksanaan pasien (dan atau penyelenggaraan pelayanan kesehatan) secara eksplisit dan sistematis berdasarkan bukti penelitian terakhir yang sahih (valid) dan bermanfaat. Penerapan “Evidence-based Medicine (EBM)” dan “Clinical Governance” dalam suatu sistem organisasi pelayanan kesehatan memerlukan beberapa persyaratan yakni organisastion-wide transformation, clinical leadership dan positive organizational cultures. 

Review Paper: Epidemiology, Evidence-Based Medicine, and Public Health

2009 ◽  
Vol 21 (3) ◽  
pp. 244-251 ◽  
Author(s):  
Jin-Ling Tang ◽  
Sian Griffiths
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Medicine ◽  
Clinical Care ◽  
Public Health Practice ◽  
Medical Decision ◽  
Evidence Based ◽  
Public Health Decision ◽  
Based Medicine

This article reviews the relation between evidence-based medicine and epidemiology and the recent evolution of the former. The meaning of evidence and the international efforts to collect, summarize, and disseminate findings from scientific research that are relevant for medical decision making are discussed. Evidence, current resources, and people's values, all play a role in making evidence-based medical decisions. This also has important implications for public health practice. However, decision making differs considerably between clinical care of individual patients and public health decision and policies that normally apply to populations. Although more closely related to epidemiology than clinical medicine, public health should also adopt a more systematic approach to evidence-based practice.

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