Over the past decade, health care professionals have seen a shift in medical philosophy from simply caring for patients to demonstrating that they can achieve measured efficacy and safety outcomes of care. The increased use of scientific methods to compare outcomes achieved with different care modalities has created a growing body of evidence on which to base medical care decisions.
Known as evidence-based medical practice, or evidence-based medicine (EBM), this approach encompasses diagnostic, treatment, and preventive procedures, including drug and medical device use. This article will define EBM and describe how clinicians can use it as a powerful tool to enhance clinical, humanistic, and economic outcomes of patient care.
Hallmarks of EBM
Evidence-based medicine is defined as the “use of current best evidence to inform decisions about the care of an individual patient.”1 Its hallmarks are (1) focusing on achieving desired patient-centered outcomes of care rather than on delivering care, (2) including the patient as an informed participant in the decision about the choice of care modalities, (3) basing care decisions on the best available evidence of treatment efficacy, likelihood and severity of complications, and costs.2
Skin and wound care professionals using EBM apply their knowledge of the best available evidence, including benefits and risks of a specific care modality, to inform patients about their care options. In other words, they examine what works best for a particular patient's condition and what will help meet his or her quality of life and economic goals with the fewest complications or adverse effects. Thus informed, the patient can participate in the choice of therapy to meet his or her goals and lifestyle.
The concept of EBM is not limited to one profession, one type of patient, or one care setting. It has universal applicability for any health care professional, including physicians of all specialties, nurses of all levels of expertise and specialties, physical and occupational therapists, physician assistants, and nutritional and metabolic specialists. Evidence-based medicine can be applied to inpatients or outpatients in all health care settings, including acute care, subacute care, physician offices, wound care clinics or specialty care centers, rehabilitation facilities, and home care.
Levels of Evidence
To educate their patients, skin and wound care professionals need to recognize the best evidence available for each modality they may consider using.
Not every modality has the same level of evidence, of course. The lowest quality of evidence is expert opinion. Measured observations or descriptions are somewhat better, particularly if they apply to a defined set of patients using a defined standard practice. Comparative studies provide stronger evidence to identify which of 2 or more modalities is more effective in achieving measured outcomes under standardized conditions. Such comparative studies are the gold standard of medical evidence, when each patient in a controlled trial is randomly assigned to a treatment group.
The hallmarks of good evidence have been summarized in the literature.2–5 See Table 1 for a list of tools that would help busy clinicians summarize evidence.
Weighing the Benefits
Although EBM remains controversial to some,6 its benefits outweigh its limitations.7 Practitioners of EBM tend to achieve better, more reliable, and safer outcomes, with more consistent care for their patients and less legal liability than those who do not use EBM. Moreover, reimbursement authorities increasingly rely on evidence to make reimbursement decisions.7
Skin and wound care professionals can help their patients receive the best clinical, humanistic, and economic outcomes that current medical science can offer by applying EBM to their care decisions.
1. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996;312(7023):71–2.
2. Jaeschke R, Guyatt GH, Meade M. Evidence-based practice: what it is, why we need it. Adv Wound Care 1998;11:214–8.
3. van Rijswijk L. Nursing research and dermatology: where to start. Dermatol Nurs 1990;2:158–61.
4. Meakins J. Innovation in surgery: the rules of evidence. Am J Surg 2002;183:399–405.
5. Gray M, Beitz J, Colwell J, et al. Evidence-based nursing practice. II: Advanced concepts for WOC nursing practice. J Wound Ostomy Continence Nurs 2004;31:53–61.
6. Falanga V. The dark side of evidence-based wound management. J Wound Care 2001;10:145.
7. Whyte J, Hill H, Kang J. Evidence-based assessment of medical technology. JAMA 2000;283:2792–3.