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Evidence-Based Practice

Before you begin

  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.

Measuring clinical outcomes

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?

Reducing costs

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.

Clinical outcomes measure databases