1. Clarify and state your question - see PICO
2. Acquire the evidence - see Finding Evidence
3. Appraise and synthesize the evidence - see Appraising the literature

Evaluate clinical decisions and services on the basis of:

• Positive impact on the health of the individual (and the population)
• Positive experiences for the patient
• Total cost must be reasonable

These factors are based on the Triple Aim Initiative, developed by the Institute for Healthcare Improvement as a framework designed to enhance health system performance.

Applying the Evidence Worksheet - View and download PDF from Dartmouth Biomedical Libraries.

Evaluate health outcomes and patient experiences by measuring your clinical outcomes. Before selecting a clinical outcome measure, answer the following questions:

• What is your construct of interest? What is the goal(s) of your intervention?
• What is the population or patient/client group?
• What is the level of mobility or ability?
• What is your desired outcome(s)?
• How will you keep track of the data?

Once you identify a potential measure, ensure that it is appropriate to answer your clinical practice question:

• Does the measure have evidence of reliability and validity?
• What is the clinical applicability of the measure? What tools do you need and how much time does it take?
• Has the measure been used with your population of interest?
• Are there normative, cutoff, MCD or MCID data? How will you interpret the score?

Medical necessity may be determined through cost-benefit analyses and risk-benefit analyses.

• Cost-benefit refers to the resource expenditures relative to potential medical benefits.
• Risk-benefit compares the potential undesirable outcomes/side effects with the potential for desirable outcomes.