Implementation of Evidence-Based Care

Prior to the evolution of evidence-based medicine, medical practice was largely based on personal experience and widely accepted, but unproven theories. This often resulted in negative patient outcomes, which led to an increasing awareness that a standardized method to guide clinical practice was needed. This led to the advent of the evidence-based model, which focuses on answering a clinical question. With the practice of evidence-based medicine also came the need to improve current processes in order to continually provide quality, patient-centered care, i.e., the model for improvement. While both evidence-based model and the model for improvement are often considered separately, they are arguably linked together. Once evidence-based knowledge is organized into a guideline, policy, or procedure, it must be implemented into practice. This is a very complex task and must take into account many factors that will guide success or failure. Some of these factors are the desire and capacity to change, a gap where implementing knowledge will lead to an improved outcome, as well as internal and external cultural influences. Using a quality improvement method, such as the model for improvement, will allow for small tests of change and adjustments that will lead to stabilization when new evidence is implemented. Sustaining change is the final step and will require transparent feedback and data as well as ongoing evaluation of new evidence to achieve the best possible outcome.