Evidence-Based Medicine
Origin
The origin of evidence-based medicine (EBM) traces back to the mid-19th century. The Cochrane Collaboration and Britain's Centre for Reviews and Dissemination, a formal United Kingdom-based program, is one of the leaders in developing evidence-based medicine. Additional international resources include the National Institute for Health and Clinical Excellence, also in the UK, as well as the Joanna Briggs Institute in Australia. In the United States, the Agency for Healthcare Research and Quality (AHRQ) has developed many clinical guidelines to direct the EBM movement, which can be viewed through the AHRQ-sponsored National Guidelines Clearinghouse.
Definition
Evidence-based medicine (EBM), as originally defined by the Canadian Evidence-Based Medicine Working Group (EBMWG) in 1992, “de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research” (EBMWG, 1992, p.2420) Over time, the definition began to expand to clarify the role of additional forms of evidence beyond clinical research results. A frequently cited definition by Sackett et al. (2000) states that EBM should include “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine requires the integration of individual clinical expertise with the best available external clinical evidence from systematic research and our patient’s unique values and circumstances.”
Though EBM remains a frequently used term, the expanded concept of Evidence-Based Practice more formally describes the relationships between scientific evidence, clinician experience and patient preferences into clinical practice.
Evidence-based medical practice has five components identified by Steves (2004):
- Defining a clinically relevant question
- Searching for the best evidence
- Appraising the quality of the evidence
- Applying the evidence to clinical practice
- Evaluation of the process