Evidence-Based Medicine

What are evidence-based medicine (EBM) and evidence-based practice (EBP)? According to the international organization the Cochrane Collaboration, as well as various prominent researchers and [Page 289]practitioners such as David Sackett, Iain Chalmers, and Paul Glasziou, EBM is the use of current best evidence in making decisions about the care of patients or the delivery of health services.

While EBM was the first term coined for this approach to clinical practice, it quickly became clear that an evidence-based approach also applies to nursing, allied health, and other forms of clinical practice, and so the term EBP is now more widely used because it encapsulates the evidence-based approach to clinical decision making.

EBP is the integration of the best available clinical evidence from systematic reviews of relevant research with clinical expertise and patient preferences and values, and the implementation and evaluation of the use of best evidence in practice. A key element of EBP is to make sense of multiple research studies by evaluating study quality and analyzing aggregated outcomes to get an overall summary of the validity and outcomes.

The field of EBP owes much of its impetus to the Cochrane Collaboration, founded in 1993 and named after the British epidemiologist Archie Cochrane (1909–1988). The Cochrane Collaboration is an international not-for-profit organization that produces systematic reviews of evidence regarding the effectiveness of health care interventions. The reviews are used to help inform evidence-based decision making in health care settings. They are created by hundreds of contributors worldwide.

Synthesis of evidence is practiced not only at this international level, but also on national and local levels, where universities and health services may have centers doing reviews of evidence to inform and answer specific clinical questions to inform EBP. Well-known centers involved in this effort include the Centre for Reviews and Dissemination at the University of York, various McMaster University centers, and the Centre for Evidence Based Medicine at the University of Oxford.

The complete process of integrating evidence into health care decision making has five steps, which are discussed in detail in the “Further Readings” list and are also summarized below.