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. 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

5. 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

6. 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

7. 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

8. 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