This blog post excerpts an article by Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, chief nurse for Wolters Kluwer/Lippincott, in the Spring 2015 issue of HealthStream's PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience.
A New Paradigm in Healthcare
Gone are the days of the fee-for-service model. Enter the Value-based Purchasing (VBP) model, where the care you deliver and the patient outcomes you achieve determine the amount of reimbursement the institution or healthcare professional receives. Patient outcomes and safety are the top priorities in healthcare. The challenge every healthcare institution and healthcare professional faces each day is how to provide cost-effective, evidence-based patient care that improves patient outcomes. This country did not move to this model overnight.
The 1999 report by the Institute of Medicine (IOM), “To Err is Human,” reported up to 98,000 patients die each year in the U.S. due to medical errors that could have been prevented. A study by Gray, et al. (2002), showed that only 20% of the care healthcare professionals provide is based on evidence. In 2001, the IOM released a study that showed patients received the recommended evidence-based course of treatment only 55% of the time.
The strain on the current healthcare system increased in 2010, when the Patient Protection and Affordable Care Act was passed, giving access to healthcare to more than 30 million Americans. Using evidence to inform practice and assist healthcare professionals with clinical decision-making to improve patient outcomes is paramount to having a successful healthcare system. According to the IOM, billions of dollars have been wasted, and one million people have lost their lives due to safety issues and poor practice .
Transforming Into an Evidence-Based Organization
How do healthcare institutions and clinicians provide the best patient care, and yet do it cost-effectively and with improved outcomes? The answer is by implementing evidence-based practice (EBP) throughout their organizations. Evidence-based practice is an approach to clinical decision-making that integrates the best available evidence with a clinician’s expertise, while taking into consideration the patient’s preferences and values. Evidence can come from well-developed primary research studies, such as randomized controlled trials, or secondary research, such as systematic reviews and meta-analyses or meta-syntheses. Clinical intelligence and expertise from practice can also inform practice changes, for example, from quality improvement projects and from electronic healthcare record (EHR) data. Evidence can come from continuing education articles and activities, which are developed to educate healthcare professionals on new concepts, principles, and interventions that will change how clinicians practice. In essence, it is knowledge transferred from experts to clinicians who will use the information to inform and improve their practice. How do healthcare organizations implement evidence into practice? There are many models available, but they predominantly follow a similar format:
- Develop the clinical question
- Generate or search for the evidence
- Appraise or synthesize the evidence
- Implement the evidence
- Evaluate outcomes
Before an organization gets started on its EBP journey, it needs to be sure the culture of the organization is ready for it. Too often, organizations and clinicians find themselves stuck doing things the way they have always been done. Recognizing that the old way is not always the best way is the first step to moving an organization toward being one that embraces evidence in practice.
This article also discusses the Steps for Implementing Evidence Into Practice:
- Step 1: Develop the clinical question.
- Step 2: Search for the best available evidence.
- Step 3: Appraise the evidence.
- Step 4: Implement the evidence into practice.
- Step 5: Evaluate the outcome.
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About the Author
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, is a chief nurse for Wolters Kluwer/Lippincott and Ovid Technologies, a market-leading information services and publishing company—in Philadelphia, PA. She is also a nurse practitioner at Penn Medicine, Chester County Hospital in West Chester, PA, and an adjunct faculty member at Drexel University, also in Philadelphia.