scholarly journals Proposal of a Holistic Model to Support Local-Level Evidence-Based Practice

2010 ◽  
Vol 10 ◽  
pp. 1520-1529
Author(s):  
Said Shahtahmasebi ◽  
Luis Villa ◽  
Helen Nielsen ◽  
Hilary Graham-Smith
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Practice ◽  
Local Level ◽  
Policy Formation ◽  
Decision Makers ◽  
Evidence Based ◽  
Holistic Model ◽  
Local Evidence ◽  
External Evidence

In response to a central drive for evidence-based practice, there have been many research support schemes, setups, and other practices concentrating on facilitating access to external research, such as the Centre for Evidence Based Healthcare Aotearoa, the Cochrane Collaboration, and the York Centre for Reviews and Dissemination. Very little attention has been paid to supporting internal research in terms of local evidence and internal research capabilities. The whole evidence-based practice movement has alienated internal decision makers and, thus, very little progress has been made in the context of evidence informing local policy formation. Health and social policies are made centrally based on dubious claims and often evidence is sought after implementation. For example, on record, most health care practitioners appear to agree with the causal link between depression and mental illness (sometimes qualified with other social factors) with suicide; off the record, even some psychiatrists doubt that such a link is applicable to the population as a whole. Therefore, be it through misplaced loyalty or a lack of support for internal researchers/decision makers, local evidence informing local decision making may have been ignored in favour of external evidence. In this paper, we present a practical holistic model to support local evidence-based decision making. This approach is more relevant in light of a new approach to primary health care of “local knowledge” complementing external evidence. One possible outcome would be to network with other regional programmes around the world to share information and identify “best” practices, such as the “Stop Youth Suicide Campaign”(www.stopyouthsuicide.com).

scholarly journals Decision-Making and Sources of Evidence in Occupational Therapy and Other Health Professions. Evidence-Informed Practice / Entscheidungsfindung und Evidenzquellen in der Ergotherapie und weiteren Gesundheitsberufen. Evidenzinformierte Praxis

2014 ◽  
Vol 1 (1) ◽  
pp. 13-19 ◽  
Author(s):  
George S. Tomlin ◽  
Deborah Dougherty
Keyword(s):  
Decision Making ◽  
Occupational Therapy ◽  
Evidence Based Practice ◽  
Health Professions ◽  
Evidence Based ◽  
External Evidence ◽  
Published Evidence ◽  
Pyramid Model ◽  
Valid Evidence ◽  
Theoretical Paper

Abstract Contemporary conditions require health professionals both to employ published evidence in their individual practices and as a profession to produce valid evidence of their outcome effectiveness. Heretofore, these two processes of evidence-based practice have often been confounded as one. This theoretical paper separates the two processes into «Evidence-Supported Practice» and «Evidence-Informed Practice.» Each requires a different approach to evidence accumulation and use. Nonetheless, the two processes can and should be interlinked. For external (research) evidence, the research pyramid model values equally the internal and external validity of studies, as both are important for the implementation of external evidence. Furthermore, external evidence must be combined with internal evidence (data generated in the course of interaction with a client) in the decision-making of practitioners. Examples from recent research on occupational therapy practice and literature from several other health professions are cited for illustration. This paper formulates a more comprehensive model for evidence-based practice. From this model follow specific recommendations for practitioners, researchers, and educators in the health professions.

scholarly journals Exploring the Use of Evidence From the Development and Evaluation of an Electronic Health (eHealth) Trial: Case Study

10.2196/17718 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e17718
Author(s):  
Monika Jurkeviciute ◽  
Henrik Eriksson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Patient Preferences ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Professional Experience ◽  
Evidence Based ◽  
Policy Decisions ◽  
Professional Experiences

Background Evidence-based practice refers to building clinical decisions on credible research evidence, professional experience, and patient preferences. However, there is a growing concern that evidence in the context of electronic health (eHealth) is not sufficiently used when forming policies and practice of health care. In this context, using evaluation and research evidence in clinical or policy decisions dominates the discourse. However, the use of additional types of evidence, such as professional experience, is underexplored. Moreover, there might be other ways of using evidence than in clinical or policy decisions. Objective This study aimed to analyze how different types of evidence (such as evaluation outcomes [including patient preferences], professional experiences, and existing scientific evidence from other research) obtained within the development and evaluation of an eHealth trial are used by diverse stakeholders. An additional aim was to identify barriers to the use of evidence and ways to support its use. Methods This study was built on a case of an eHealth trial funded by the European Union. The project included 4 care centers, 2 research and development companies that provided the web-based physical exercise program and an activity monitoring device, and 2 science institutions. The qualitative data collection included 9 semistructured interviews conducted 8 months after the evaluation was concluded. The data analysis concerned (1) activities and decisions that were made based on evidence after the project ended, (2) evidence used for those activities and decisions, (3) in what way the evidence was used, and (4) barriers to the use of evidence. Results Evidence generated from eHealth trials can be used by various stakeholders for decisions regarding clinical integration of eHealth solutions, policy making, scientific publishing, research funding applications, eHealth technology, and teaching. Evaluation evidence has less value than professional experiences to local decision making regarding eHealth integration into clinical practice. Professional experiences constitute the evidence that is valuable to the highest variety of activities and decisions in relation to eHealth trials. When using existing scientific evidence related to eHealth trials, it is important to consider contextual relevance, such as location or disease. To support the use of evidence, it is suggested to create possibilities for health care professionals to gain experience, assess a few rather than a large number of variables, and design for shorter iterative cycles of evaluation. Conclusions Initiatives to support and standardize evidence-based practice in the context of eHealth should consider the complexities in how the evidence is used in order to achieve better uptake of evidence in practice. However, one should be aware that the assumption of fact-based decision making in organizations is misleading. In order to create better chances that the evidence produced would be used, this should be addressed through the design of eHealth trials.

scholarly journals Medicine and interest politics a study of decision-making processes in the area of vascular surgery in Norway

2020 ◽  
Vol 34 (4) ◽  
pp. 427-447
Author(s):  
Kjersti Wendt ◽  
Bjørn Erik Mørk ◽  
Ole Trond Berg ◽  
Erik Fosse
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Vascular Surgery ◽  
Public Involvement ◽  
Local Level ◽  
Clinical Care ◽  
Decision Makers ◽  
Content Type ◽  
Rational Distribution ◽  
Decision Making Processes

PurposeThe purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway.Design/methodology/approachThe study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way.FindingsBoth decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.Practical implicationsDecision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions.Originality/valueThis paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

scholarly journals Exploring the Use of Evidence From the Development and Evaluation of an Electronic Health (eHealth) Trial: Case Study (Preprint)

2020 ◽  
Author(s):  
Monika Jurkeviciute ◽  
Henrik Eriksson
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Patient Preferences ◽  
Research Evidence ◽  
Evidence Based Practice ◽  
Scientific Evidence ◽  
Professional Experience ◽  
Evidence Based ◽  
Policy Decisions ◽  
Professional Experiences

BACKGROUND Evidence-based practice refers to building clinical decisions on credible research evidence, professional experience, and patient preferences. However, there is a growing concern that evidence in the context of electronic health (eHealth) is not sufficiently used when forming policies and practice of health care. In this context, using evaluation and research evidence in clinical or policy decisions dominates the discourse. However, the use of additional types of evidence, such as professional experience, is underexplored. Moreover, there might be other ways of using evidence than in clinical or policy decisions. OBJECTIVE This study aimed to analyze how different types of evidence (such as evaluation outcomes [including patient preferences], professional experiences, and existing scientific evidence from other research) obtained within the development and evaluation of an eHealth trial are used by diverse stakeholders. An additional aim was to identify barriers to the use of evidence and ways to support its use. METHODS This study was built on a case of an eHealth trial funded by the European Union. The project included 4 care centers, 2 research and development companies that provided the web-based physical exercise program and an activity monitoring device, and 2 science institutions. The qualitative data collection included 9 semistructured interviews conducted 8 months after the evaluation was concluded. The data analysis concerned (1) activities and decisions that were made based on evidence after the project ended, (2) evidence used for those activities and decisions, (3) in what way the evidence was used, and (4) barriers to the use of evidence. RESULTS Evidence generated from eHealth trials can be used by various stakeholders for decisions regarding clinical integration of eHealth solutions, policy making, scientific publishing, research funding applications, eHealth technology, and teaching. Evaluation evidence has less value than professional experiences to local decision making regarding eHealth integration into clinical practice. Professional experiences constitute the evidence that is valuable to the highest variety of activities and decisions in relation to eHealth trials. When using existing scientific evidence related to eHealth trials, it is important to consider contextual relevance, such as location or disease. To support the use of evidence, it is suggested to create possibilities for health care professionals to gain experience, assess a few rather than a large number of variables, and design for shorter iterative cycles of evaluation. CONCLUSIONS Initiatives to support and standardize evidence-based practice in the context of eHealth should consider the complexities in how the evidence is used in order to achieve better uptake of evidence in practice. However, one should be aware that the assumption of fact-based decision making in organizations is misleading. In order to create better chances that the evidence produced would be used, this should be addressed through the design of eHealth trials.

Integrating Evidence-Based Practice in Athletic Training

2017 ◽  
pp. 1368-1378
Author(s):  
Brittany A. Vorndran ◽  
Michelle Lee D'Abundo
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Continuing Education ◽  
Athletic Training ◽  
Health Care Professional ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Athletic Trainers ◽  
Clinical Decision ◽  
Evidence Based

Evidence-based practice (EBP) involves a health care professional using his or her own knowledge, the current research published, and the needs of the patient to make the best clinical decision. This has been a hot topic in many different branches of healthcare and recently athletic trainers have begun to embrace its importance. In December of 2015, athletic trainers (ATs) will need to have completed ten of their fifty continuing education units (CEUs) in EBP to maintain certification. While ATs recognize the significance of implementing EBP into clinical decision making, there are many barriers slowing the change. This chapter includes information about how EBP is currently being used by athletic training clinicians and educators, the barriers ATs perceive to using EBP, the importance of using EBP, and managing the transition needed to successfully adopt the use of EBP.

EBM: Rationalist Fever Dreams

2018 ◽  
Vol 12 (3) ◽  
pp. 227-230 ◽  
Author(s):  
Devorah Klein ◽  
David Woods ◽  
Gary Klein ◽  
Shawna Perry
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Best Practice ◽  
Decision Makers ◽  
Evidence Based ◽  
Naturalistic Decision Making ◽  
The Face ◽  
Based Medicine

In 2016, we examined the connection between naturalistic decision making and the trend toward best practice compliance; we used evidence-based medicine (EBM) in health care as an exemplar. Paul Falzer’s lead paper in this issue describes the historical underpinnings of how and why EBM came into vogue in health care. Falzer also highlights the epistemological rationale for EBM. Falzer’s article, like our own, questions the rationale of EBM and reflects on ways that naturalistic decision making can support expertise in the face of attempts to standardize practice and emphasize compliance. Our objectives in this commentary are first to explain the inherent limits of procedural approaches and second to examine ways to help decision makers become more adaptive.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

CAN BAYESIAN METHODS MAKE DATA AND ANALYSES MORE RELEVANT TO DECISION MAKERS?

2001 ◽  
Vol 17 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Steven H. Sheingold
Keyword(s):  
Decision Making ◽  
Bayesian Methods ◽  
Paradigm Shift ◽  
Relevant Information ◽  
Decision Makers ◽  
Evidence Based ◽  
Critical Importance ◽  
Bayesian Approaches ◽  
Bayesian Analyses ◽  
And Performance

Decision making in health care has become increasingly reliant on information technology, evidence-based processes, and performance measurement. It is therefore a time at which it is of critical importance to make data and analyses more relevant to decision makers. Those who support Bayesian approaches contend that their analyses provide more relevant information for decision making than do classical or “frequentist” methods, and that a paradigm shift to the former is long overdue. While formal Bayesian analyses may eventually play an important role in decision making, there are several obstacles to overcome if these methods are to gain acceptance in an environment dominated by frequentist approaches. Supporters of Bayesian statistics must find more accommodating approaches to making their case, especially in finding ways to make these methods more transparent and accessible. Moreover, they must better understand the decision-making environment they hope to influence. This paper discusses these issues and provides some suggestions for overcoming some of these barriers to greater acceptance.

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