Fundamentals of Evidence-Based Care: How to Find, Evaluate, and Use Evidence in Your Quality Journey

Fundamentals of Evidence-Based Care:  How to Find, Evaluate, and Use Evidence in  Your Quality Journey


Helen Wu, PhD; Craig Robbins, MD, MPH, FAAFP;
Qiana Amos, MPH; Mary E White, MLS

The term “evidence based” is a common catchphrase that suggests an intervention or practice is backed by science and thus proven to work. The promise of evidence-based care is not always realized, however, because of substantial variation in how evidence is defined, identified, evaluated, and applied. We addressed these discrepancies in a multifaceted, minicourse format that outlined how to build a strong evidence-based foundation for quality improvement (QI) within the Plan phase of a Plan-Do-Study-Act (PDSA) cycle. First, we established a common definition of “evidence-based”: The integration of best research evidence with clinical expertise and patient values. Core principles include the use of systematic, a priori methods, in contrast with nonsystematic approaches. Then, we described information resources for finding evidence, including PubMed, Cochrane, UpToDate, and DynaMed. The evidence quality in all these resources is mixed, and users should be aware of the limitations. Next, we reviewed A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the Appraisal of Guidelines for Research and Evaluation (AGREE II), tools with accepted frameworks for critically appraising systematic reviews and clinical practice guidelines, respectively. Kaiser Permanente’s National Guideline Program uses these tools to evaluate the credibility of such resources, which often have important gaps and limitations. Finally, we shared insights about translating evidence into action, describing ways to assess the overall strength and relevance of a body of evidence and the need to implement interventions in a manner that balances local adaptation with fidelity to the evidence.

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