What's All This about Evidence-Based Practice? the Roots, the Controversies, and Why It Matters

One can almost hear the 1970s "Saturday (Night Live" character Emily Litella starting her weekly rant: "So what is evidence-based practice and why has it become such a hot topic in healthcare, social services and long-term care?" Does evidence-based practice represent a paradigm change in improving how services are delivered, or is it another practice and policy experiment that will slip away and join other promising innovations of yesteryear? The concepts underlying evidence-based practice have long-standing roots in efforts to provide assistance to individuals. During the Crimean War in the 1850s, Florence Nightingale was engaged in evidence-based practice when she noted a connection between poor sanitary conditions in the hospital and rising death rates among wounded soldiers. Her subsequent efforts to sanitize hospitals to save soldiers led to dramatic drops in patient mortality (Baker, 1983). Her methods- a process of identifying, critically appraising, and summarizing the best available evidence- were a precursor of today's standards for evidence-based practice. The major helping disciplines, from medicine, nursing, the allied professions, social work, psychology, and education, have all engaged in lengthy debates about effectiveness of treatments or programs and the use of evidence from empirical research to guide practice (Fischer, 1978; Hubble, Duncan, and Miller, 1999; Rizzo and Rowe, 2006; Long and Moore, 2008). These days, however, evidencebased practice is a source of disagreement and controversy. For example, some engaged in recent efforts to make practices more evidence-based present the endeavor as something new that must be adopted, rather than as a venerable tool with a rich history on which to build. And, amidst consistent and growing criticism that we are not effectively incorporating evidence-based information into everyday practices, programs, and policies, a significant number of practitioners regard evidence-based practice as a threat to good provision of care. As efforts continue to make practice more effective, understanding these ongoing tensions will be critical. Evolution of Evidence-Based Practice Although there are a range of disciplinary examples of efforts to make practice evidencebased, much of the discussion seems to have been derived from the medical arena. Tracing the philosophical origins of evidence-based medicine "to mid-nineteenth century Paris and earlier," Sackett (1996, pg. 3) defines the process as the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." Although the term evidence-based medicine reportedly was first used in the 1980s (Rosenberg and Donald, 1995), the practice gained wide recognition in 1992, when the Journal of the American Medical Association published an article by the Evidence-Based Medicine Working Group (1992) on its role in medical education. That article "brought both the label and the underlying philosophy to the attention of a wider medical community" (Montori and Guyatt, 2008). Much of the discussion about evidencebased practice in the aging arena has been spurred by the work of the Center for Healthy Aging at the National Council on Aging (NCOA) and the U.S. Administration on Aging's (AoA)Evidence-based Prevention Programs for the Elderly Initiative (NCOA, 2006). According to NCOA, the purpose of AoA's initiative is "to provide knowledge of effective content and methods for translation into programs that service providers can apply to improve the health of individuals and groups" (p.3). It is within this contemporary context that we take up a discussion of evidence-based practice in the provision of aging services (as represented by the aging network) Here we argue that the lessons and challenges arising from medicine's experience with this approach apply to the aging network, but not directly; in many instances, fundamental differences exist between the two fields of practice. …